Higher versus lower positive end-expiratory pressure in patients without acute respiratory distress syndrome: a meta-analysis of randomized controlled trials

Critical Care

Giovanni Landoni¹  Francesco Zarantonello²  Tommaso Pettenuzzo²  Alessandro De Cassai²  Annalisa Boscolo²  Laura Pasin²  Paolo Persona²  Nicolò Sella³  Paolo Navalesi³ 

[1] Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy;School of Medicine, Vita-Salute San Raffaele University, Milan, Italy;Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy;Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy;Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Padua, Italy;

关键词: Mechanical ventilation;    Positive end-expiratory pressure;    Mortality;    Meta-analysis;   

DOI  :  10.1186/s13054-021-03669-4

来源: Springer

【 摘 要 】

BackgroundWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the association of higher positive end-expiratory pressure (PEEP), as opposed to lower PEEP, with hospital mortality in adult intensive care unit (ICU) patients undergoing invasive mechanical ventilation for reasons other than acute respiratory distress syndrome (ARDS).MethodsWe performed an electronic search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science from inception until June 16, 2021 with no language restrictions. In addition, a research-in-progress database and grey literature were searched.ResultsWe identified 22 RCTs (2225 patients) comparing higher PEEP (1007 patients) with lower PEEP (991 patients). No statistically significant association between higher PEEP and hospital mortality was observed (risk ratio 1.02, 95% confidence interval 0.89–1.16; I2 = 0%, p = 0.62; low certainty of evidence). Among secondary outcomes, higher PEEP was associated with better oxygenation, higher respiratory system compliance, and lower risk of hypoxemia and ARDS occurrence. Furthermore, barotrauma, hypotension, duration of ventilation, lengths of stay, and ICU mortality were similar between the two groups.ConclusionsIn our meta-analysis of RCTs, higher PEEP, compared with lower PEEP, was not associated with mortality in patients without ARDS receiving invasive mechanical ventilation. Further large high-quality RCTs are required to confirm these findings.

【 授权许可】

CC BY