دورية أكاديمية
Effects of higher PEEP and recruitment manoeuvres on mortality in patients with ARDS: a systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials
| العنوان: | Effects of higher PEEP and recruitment manoeuvres on mortality in patients with ARDS: a systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials |
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| المؤلفون: | Ball, Lorenzo, Serpa Neto, Ary, Trifiletti, Valeria, Mandelli, Maura, Firpo, Iacopo, Robba, Chiara, Gama de Abreu, Marcelo, Schultz, Marcus J, Patroniti, Nicolò, Rocco, Patricia R M, Pelosi, Paolo |
| المساهمون: | Ball, Lorenzo, Serpa Neto, Ary, Trifiletti, Valeria, Mandelli, Maura, Firpo, Iacopo, Robba, Chiara, Gama de Abreu, Marcelo, Schultz, Marcus J, Patroniti, Nicolò, Rocco, Patricia R M, Pelosi, Paolo |
| سنة النشر: | 2020 |
| المجموعة: | Università degli Studi di Genova: CINECA IRIS |
| مصطلحات موضوعية: | Acute respiratory distress syndrome, Mechanical ventilation, Positive end-expiratory pressure |
| الوصف: | Purpose: In patients with acute respiratory distress syndrome (ARDS), lung recruitment could be maximised with the use of recruitment manoeuvres (RM) or applying a positive end-expiratory pressure (PEEP) higher than what is necessary to maintain minimal adequate oxygenation. We aimed to determine whether ventilation strategies using higher PEEP and/or RMs could decrease mortality in patients with ARDS. Methods: We searched MEDLINE, EMBASE and CENTRAL from 1996 to December 2019, included randomized controlled trials comparing ventilation with higher PEEP and/or RMs to strategies with lower PEEP and no RMs in patients with ARDS. We computed pooled estimates with a DerSimonian-Laird mixed-effects model, assessing mortality and incidence of barotrauma, population characteristics, physiologic variables and ventilator settings. We performed a trial sequential analysis (TSA) and a meta-regression. Results: Excluding two studies that used tidal volume (VT) reduction as co- intervention, we included 3870 patients from 10 trials using higher PEEP alone (n = 3), combined with RMs (n = 6) or RMs alone (n = 1). We did not observe differences in mortality (relative risk, RR 0.96, 95% confidence interval, CI [0.84–1.09], p = 0.50) nor in incidence of barotrauma (RR 1.22, 95% CI [0.93–1.61], p = 0.16). In the meta- regression, the PEEP difference between intervention and control group at day 1 and the use of RMs were not associated with increased risk of barotrauma. The TSA reached the required information size for mortality (n = 2928), and the z-line surpassed the futility boundary. Conclusions: At low VT, the routine use of higher PEEP and/or RMs did not reduce mortality in unselected patients with ARDS. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | STAMPA |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/33336325; info:eu-repo/semantics/altIdentifier/wos/WOS:000601213300011; volume:8; firstpage:39; lastpage:54; numberofpages:16; journal:INTENSIVE CARE MEDICINE EXPERIMENTAL; http://hdl.handle.net/11567/1035136Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85101754329 |
| DOI: | 10.1186/s40635-020-00322-2 |
| الإتاحة: | https://doi.org/10.1186/s40635-020-00322-2Test http://hdl.handle.net/11567/1035136Test |
| رقم الانضمام: | edsbas.479A6EA2 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s40635-020-00322-2 |
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