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[The influence of high positive end-expiratory pressure ventilation combined with low tidal volume on prognosis of patients with acute lung injury/acute respiratory distress syndrome: a Meta-analysis].

Abstract

OBJECTIVE

To compare the effects of high and low positive end-expiratory pressure (PEEP) levels on prognosis of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS).

METHODS

The data in PubMed, EMbase, Cochrane Library, CBM and CNKI were retrieved. All randomized controlled trials (RCTs) of treatment of ALI/ARDS with PEEP with high or low level were included. Study selection and assessment, data collection and analyses were undertaken by two independent reviewers. Meta-analyses were done using Cochrane Collaboration's RevMan 5.0 software.

RESULTS

Six RCTs, involving a total of 2 484 patients of ALI/ARDS were included in the review. According to ventilation strategy, all trials were divided into subgroup A (high PEEP+low tidal volume of 6 ml/kg vs. low PEEP+low tidal volume) and subgroup B (high PEEP+low tidal volume vs. low PEEP+traditional tidal volume). In subgroup B, there were three RCTs, and high PEEP was found to be associated with a lower 28-day mortality [odds ratio (OR)=0.40, 95% confidence interval (95%CI) 0.22-0.72, P=0.003] and a lower barotraumas (OR=0.20, 95%CI 0.05-0.82, P=0.02) in patients with ALI/ARDS. In subgroup A, there were three RCTs, and it was found that the differences in 28-day mortality (OR=0.86, 95%CI 0.72-1.02, P=0.08) and barotraumas (OR=1.19, 95%CI 0.89-1.58, P=0.25) were not significant .

CONCLUSION

As compared with conventional ventilation, high PEEP and low tidal volume ventilation are associated with improved survival and a lower rate of barotrauma in patients with ALI/ARDS. It is necessary to further confirm the role of high PEEP only in the ventilation strategy in patients with ALI/ARDS.

Authors+Show Affiliations

Intensive Care Unit, the Third Hospital, Beijing University, Beijing 100191, China.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

chi

PubMed ID

21251358

Citation

Yang, Jun, et al. "[The Influence of High Positive End-expiratory Pressure Ventilation Combined With Low Tidal Volume On Prognosis of Patients With Acute Lung Injury/acute Respiratory Distress Syndrome: a Meta-analysis]." Zhongguo Wei Zhong Bing Ji Jiu Yi Xue = Chinese Critical Care Medicine = Zhongguo Weizhongbing Jijiuyixue, vol. 23, no. 1, 2011, pp. 5-9.
Yang J, Liu F, Zhu X. [The influence of high positive end-expiratory pressure ventilation combined with low tidal volume on prognosis of patients with acute lung injury/acute respiratory distress syndrome: a Meta-analysis]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011;23(1):5-9.
Yang, J., Liu, F., & Zhu, X. (2011). [The influence of high positive end-expiratory pressure ventilation combined with low tidal volume on prognosis of patients with acute lung injury/acute respiratory distress syndrome: a Meta-analysis]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue = Chinese Critical Care Medicine = Zhongguo Weizhongbing Jijiuyixue, 23(1), 5-9.
Yang J, Liu F, Zhu X. [The Influence of High Positive End-expiratory Pressure Ventilation Combined With Low Tidal Volume On Prognosis of Patients With Acute Lung Injury/acute Respiratory Distress Syndrome: a Meta-analysis]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011;23(1):5-9. PubMed PMID: 21251358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The influence of high positive end-expiratory pressure ventilation combined with low tidal volume on prognosis of patients with acute lung injury/acute respiratory distress syndrome: a Meta-analysis]. AU - Yang,Jun, AU - Liu,Fei, AU - Zhu,Xi, PY - 2011/1/22/entrez PY - 2011/1/22/pubmed PY - 2012/1/31/medline SP - 5 EP - 9 JF - Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue JO - Zhongguo Wei Zhong Bing Ji Jiu Yi Xue VL - 23 IS - 1 N2 - OBJECTIVE: To compare the effects of high and low positive end-expiratory pressure (PEEP) levels on prognosis of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: The data in PubMed, EMbase, Cochrane Library, CBM and CNKI were retrieved. All randomized controlled trials (RCTs) of treatment of ALI/ARDS with PEEP with high or low level were included. Study selection and assessment, data collection and analyses were undertaken by two independent reviewers. Meta-analyses were done using Cochrane Collaboration's RevMan 5.0 software. RESULTS: Six RCTs, involving a total of 2 484 patients of ALI/ARDS were included in the review. According to ventilation strategy, all trials were divided into subgroup A (high PEEP+low tidal volume of 6 ml/kg vs. low PEEP+low tidal volume) and subgroup B (high PEEP+low tidal volume vs. low PEEP+traditional tidal volume). In subgroup B, there were three RCTs, and high PEEP was found to be associated with a lower 28-day mortality [odds ratio (OR)=0.40, 95% confidence interval (95%CI) 0.22-0.72, P=0.003] and a lower barotraumas (OR=0.20, 95%CI 0.05-0.82, P=0.02) in patients with ALI/ARDS. In subgroup A, there were three RCTs, and it was found that the differences in 28-day mortality (OR=0.86, 95%CI 0.72-1.02, P=0.08) and barotraumas (OR=1.19, 95%CI 0.89-1.58, P=0.25) were not significant . CONCLUSION: As compared with conventional ventilation, high PEEP and low tidal volume ventilation are associated with improved survival and a lower rate of barotrauma in patients with ALI/ARDS. It is necessary to further confirm the role of high PEEP only in the ventilation strategy in patients with ALI/ARDS. SN - 1003-0603 UR - https://www.unboundmedicine.com/medline/citation/21251358/[The_influence_of_high_positive_end_expiratory_pressure_ventilation_combined_with_low_tidal_volume_on_prognosis_of_patients_with_acute_lung_injury/acute_respiratory_distress_syndrome:_a_Meta_analysis]_ L2 - http://www.diseaseinfosearch.org/result/210 DB - PRIME DP - Unbound Medicine ER -