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Meta-Analysis
. 2019 Jan-Dec:13:1753466619858228.
doi: 10.1177/1753466619858228.

Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) versus low PEEP on patients with moderate-severe acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

Xi Zheng  1 , Yijia Jiang  1 , Huimiao Jia  1 , Wenliang Ma  1 , Yue Han  1 , Wenxiong Li  2
Affiliations
Meta-Analysis

Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) versus low PEEP on patients with moderate-severe acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

Xi Zheng et al. Ther Adv Respir Dis. 2019 Jan-Dec.

Abstract

Background: Setting a positive end-expiratory pressure (PEEP) on patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation has been an issue of great contention. Therefore, we aimed to determine effects of lung recruitment maneuver (RM) and titrated PEEP versus low PEEP on adult patients with moderate-severe ARDS.

Methods: Data sources and study selection proceeded as follows: PubMed, Ovid, EBSCO, and Cochrane Library databases were searched from 2003 to May 2018. Original clinical randomized controlled trials which met the eligibility criteria were included. To compare the prognosis between the titrated PEEP and low PEEP groups on patients with moderate-severe ARDS (PaO2/FiO2 < 200 mmHg). Heterogeneity was quantified through the I2 statistic. Egger's test and funnel plots were used to assess publication bias.

Results: No difference was found in 28-day mortality and ICU mortality (OR = 0.97, 95% CI (0.61-1.52), p = 0.88; OR = 1.14, 95% CI (0.91-1.43), p = 0.26, respectively). Only ventilator-free days, length of stay in the ICU, length of stay in hospital, and incidence of barotrauma could be systematically reviewed owing to bias and extensive heterogeneity.

Conclusion: No difference was observed in the RM between the titrated PEEP and the low PEEP in 28-day mortality and ICU mortality on patients with moderate-severe ARDS.

Keywords: acute respiratory distress syndrome; meta-analysis; mortality; positive end-expiratory pressure; systematic review.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Summary of the evidence search and selection.
Figure 2.
Figure 2.
Risk of bias summary. Green, yellow, and red indicate low, moderate, and high risk of bias, respectively.
Figure 3.
Figure 3.
Result of Egger’s test on the four studies for 28-day mortality.
Figure 4.
Figure 4.
Funnel plot for the identification of potential publication bias in the four studies for 28-day mortality.
Figure 5.
Figure 5.
Forest map of 28-day mortality between the two groups.
Figure 6.
Figure 6.
Result of Egger’s test on the three studies for ICU mortality.
Figure 7.
Figure 7.
Funnel plot for the identification of potential publication bias in the three studies for ICU mortality.
Figure 8.
Figure 8.
Forest map of ICU mortality between the two groups.
Figure 9.
Figure 9.
Funnel plot for the identification of potential publication bias in the three studies about barotrauma.
Figure 10.
Figure 10.
Result of the influence analysis on the four studies about barotrauma.
Figure 11.
Figure 11.
Forest map of barotrauma between the two groups.
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