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2016 ; 6
(ä): 22855
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Lung ventilation strategies for acute respiratory distress syndrome: a systematic
review and network meta-analysis
#MMPMID26955891
Wang C
; Wang X
; Chi C
; Guo L
; Guo L
; Zhao N
; Wang W
; Pi X
; Sun B
; Lian A
; Shi J
; Li E
Sci Rep
2016[Mar]; 6
(ä): 22855
PMID26955891
show ga
To identify the best lung ventilation strategy for acute respiratory distress
syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central
Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science
were searched, and 36 eligible articles were included. Compared with higher tidal
volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the
hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI)
0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone
positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with
FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and
prone positioning had the greatest potential to reduce mortality, and the
possibility of receiving the first ranking was 61.6%. Permissive hypercapnia,
recruitment maneuver, and low airway pressures were most likely to be the worst
in terms of all-cause mortality. Compared with higher tidal volumes with
FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower
PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning
ventilation are associated with lower mortality in ARDS patients. Lower tidal
volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower
tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are
potential optimal strategies for ARDS patients.