Tommaso Pettenuzzo1, Annalisa Boscolo2, Alessandro De Cassai2, Nicolò Sella2,3, Francesco Zarantonello2, Paolo Persona2, Laura Pasin2, Giovanni Landoni4,5, Paolo Navalesi2,3. 1. Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy. tommasopettenuzzo@gmail.com. 2. Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy. 3. Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Padua, Italy. 4. Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Abstract
BACKGROUND: We 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). METHODS: We 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. RESULTS: We 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. CONCLUSIONS: In 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.
BACKGROUND: We 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). METHODS: We 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. RESULTS: We 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. CONCLUSIONS: In 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.
Authors: Luciano Gattinoni; John J Marini; Antonio Pesenti; Michael Quintel; Jordi Mancebo; Laurent Brochard Journal: Intensive Care Med Date: 2016-01-18 Impact factor: 17.440
Authors: Matthias Briel; Maureen Meade; Alain Mercat; Roy G Brower; Daniel Talmor; Stephen D Walter; Arthur S Slutsky; Eleanor Pullenayegum; Qi Zhou; Deborah Cook; Laurent Brochard; Jean-Christophe M Richard; Francois Lamontagne; Neera Bhatnagar; Thomas E Stewart; Gordon Guyatt Journal: JAMA Date: 2010-03-03 Impact factor: 56.272