Meta-analysis supports lung-protective ventilation for craniotomy patients

This systematic review and meta-analysis synthesized evidence on lung-protective ventilation (LPV) versus conventional ventilation in craniotomy patients. Across included studies totaling 523 patients, LPV was associated with a significantly lower risk of overall postoperative pulmonary complications (PPCs) (OR 0.30; 95% CI: 0.18–0.48). The authors also reported that LPV did not elevate intracranial pressure (ICP), though these conclusions relied on surrogate measures.

The authors rate the evidence for PPC reduction as moderate quality. Evidence regarding ICP effects is low to moderate quality and should be interpreted cautiously. The review did not quantify absolute risk reductions, and details on follow-up duration and specific ventilation protocols were not reported.

Key limitations include reliance on surrogate endpoints for ICP and heterogeneity in PPC definitions and LPV strategies across studies. The authors highlight the need for large-scale, high-quality randomized trials with standardized invasive ICP monitoring and consistent PPC definitions to validate results.

In practice, the findings suggest LPV may be a reasonable strategy to reduce pulmonary complications in craniotomy patients, without clear adverse ICP effects. Clinicians should weigh the moderate-quality evidence and await more definitive data before adopting uniform protocols.