• Eur J Anaesthesiol · Dec 2024

    Win Ratio approach for the composite outcome of postoperative pulmonary complications: Secondary analysis of a harmonised and pooled database of three randomised clinical trials.

    • Ary Serpa Neto, Niklas S Campos, Thomas Bluth, HemmesSabrine N TSNT, Carlos Ferrando, Julian Librero, Marina Soro, Lorenzo Ball, Guido Mazzinari, Marcelo Gama de Abreu, Marcus J Schultz, and for REPEAT on behalf of the PROVHILO, iPROVE and PROBESE Investigators, and the PROVE Network investigators.
    • From the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University (ASN), Department of Intensive Care Austin Hospital, Melbourne, Australia (ASN), Department of Critical Care Medicine, Hospital Israelita Albert Einstein (ASN, NSC), Pulmonary Division, Cardio-Pulmonary Department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil (ASN), Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (TB, MgdA), Department of Anaesthesiology The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (SNTH), Department of Anesthesiology Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands (SNTH), Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona (CF), CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid (CF), Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona (JL), Anesthesia and Critical Care Department, Hospital IMED Valencia, Valencia, Spain (MS), IRCCS San Martino Policlinico Hospital (LB), Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy (LB), Department of Anesthesiology and Pain Medicine, Hospital Universitario y Politécnico la Fe (GM), Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe (GM), Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain (GM), Division of Intensive Care and Resuscitation, Outcomes Research Consortium, Division of Cardiothoracic Anesthesia, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, Ohio, USA (MGdA), Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands (MS), Mahidol University, Bangkok, Thailand (MS), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MS) and Nuffield Department of Medicine, University of Oxford, Oxford, UK (MS).
    • Eur J Anaesthesiol. 2024 Dec 19.

    BackgroundThe win ratio analysis method might provide new insight on the impact of positive end-expiratory pressure (PEEP) on clinical outcomes.ObjectiveThe aim is to re-analyse the results of the 'Re-evaluation of the effects of high PEEP with recruitment manoeuvres vs. low PEEP without recruitment manoeuvres during general anaesthesia for surgery' (REPEAT) study using the win ratio analysis.DesignIndividual patient data meta-analysis.SettingThree international multicentre randomised trials.ParticipantsPatients undergoing general anaesthesia for surgery.InterventionHigh vs. low PEEP.Main Outcome MeasureHierarchical composite endpoint of: all-cause hospital mortality; hospital length of stay; need for postoperative mechanical ventilation; severe pulmonary complications; and mild pulmonary complications.ResultsA total of 3774 patients undergoing general anaesthesia for surgery were included in this analysis. The median (interquartile range [IQR]) age was 57 [45 to 68] years and 2077 (55%) were women. A total of 3 560 720 comparison pairs were produced. The high PEEP group had a higher percentage of losses than wins in hospital mortality (1.1 vs. 0.9%) and hospital length of stay (33.8 vs. 33.2%), comparable percentages of losses and wins in postoperative invasive mechanical ventilation (0.2 vs. 0.2%), a higher percentage of wins in severe complications (2.5 vs. 2.1%) and a higher percentage of ties in mild complications (18.7 vs. 3.9% wins vs. 3.3% losses). The win ratio for high PEEP compared with low PEEP group was 1.00 (95% CI 0.92 to 1.09).ConclusionNo beneficial effects of high PEEP compared with low PEEP were found in this win ratio analysis.RegistrationClinicaltrials.gov (study identifier NCT03937375).Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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