Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper


School of Nursing




General anesthesia can lead to pulmonary compromise during surgery. Nurse anesthetists in the operating room are responsible for minimizing pulmonary complications while managing ventilation through mechanical ventilation. Positive end-expiratory pressure (PEEP) can be used to improve oxygenation, prevent airway collapse and facilitate expansion of alveoli during each breath. Yet the use of PEEP varies among clinicians, as supported by the literature. The goal of this systematic review was to evaluate the impact of PEEP intra-operatively on selected respiratory outcomes. The research question was: Does the use of positive end expiratory pressure (PEEP) during surgery decrease respiratory complications 24 hours post-operative? This review was guided by the Preferred Reporting Items for Systematic Review (PRISMA) flow diagram and checklist. Within study quality was assessed with The Critical Appraisal Skills Programme (CASP) Randomised Controlled Trials Checklist and Popay’s guidelines were followed for a narrative cross study synthesis. Seven studies were included in this systematic review. Results demonstrated less impaired gas exchange with higher PEEP and overall respiratory compliance was greater in subjects who were managed with PEEP. Most PEEP groups demonstrated less pulmonary infiltrates post operatively as well as less atelectasis and pleural effusions. Using PEEP intra-operatively generated higher oxygen saturation post-operatively and fewer patients who received PEEP needed 100% oxygen in the recovery unit. This review yielded evidence related to the intraoperative use of PEEP that nurse anesthetists may use to guide their anesthesia practice.