Efficacy of Higher Positive End-Expiratory Pressure Ventilation Strategy in Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Autor:	Yamamoto R; Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, JPN., Sugimura S; Department of Medical Engineering, Faculty of Health Care Science, Himeji Dokkyo University, Hyogo, JPN., Kikuyama K; Department of Intensive Care Medicine, Showa University Hospital, Tokyo, JPN., Takayama C; Department of Intensive Care Medicine, Yokohama Rosai Hospital, Yokohama, JPN., Fujimoto J; Department of Intensive Care Medicine, Yokohama Rosai Hospital, Yokohama, JPN., Yamashita K; Division of Critical Care Center, Kochi Red Cross Hospital, Kochi, JPN., Norisue Y; Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN., Narita C; Department of Emergency Medicine, Shizuoka General Hospital, Aoiku, JPN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2022 Jul 18; Vol. 14 (7), pp. e26957. Date of Electronic Publication: 2022 Jul 18 (Print Publication: 2022).
DOI:	10.7759/cureus.26957
Abstrakt:	Previous systematic reviews and meta-analyses assessing the pooled effects of higher positive end-expiratory pressure (PEEP) failed to show significantly reduced mortality in patients with acute respiratory distress syndrome (ARDS). Some new randomized controlled trials (RCTs) have been reported and an updated systematic review is needed to evaluate the use of higher PEEP in patients with ARDS. We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Igaku-Chuo-Zasshi, ICTRP, the National Institute of Health Clinical Trials Register, and the reference list of recent guidelines. We included RCTs to compare the higher PEEP ventilation strategy with the lower strategy in patients with ARDS. Two authors independently assessed the eligibility of the studies and extracted the data. The primary outcomes were 28-day mortality. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology was used to evaluate the certainty of the evidence. Among the 6530 screened records, 16 randomized trials involving 4150 patients were included in our meta-analysis. When comparing higher PEEP versus lower PEEP, the pooled risk ratio (RR) for 28-day mortality was 0.85 (15 studies, n=4108, 95% CI 0.72 to 1.00, I 2 =58%, low certainty of evidence). Subgroup analysis by study participants with a low tidal volume (LTV) strategy showed an interaction (P for interaction, 0.001). Our study showed that in patients with ARDS, the use of higher PEEP did not significantly reduce 28-day mortality compared to the use of lower PEEP. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Yamamoto et al.)
Databáze:	MEDLINE
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