scholarly journals Efficacy of airway pressure release ventilation for acute respiratory distress syndrome: A meta-analysis

2020 ◽  
Author(s):  
Zhen Junhai ◽  
Hu Bangchuan ◽  
Gong Shijin ◽  
Yu Yihua ◽  
Yan Jing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Conventional Mechanical Ventilation ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pressure Release Ventilation

Abstract Background Airway pressure release ventilation (APRV) has been described many years, however, it is still unclear whether APRV improves outcomes in critically ill patients admitted to Intensive Care Unit with acute respiratory distress syndrome (ARDS). Methods 3 databases were searched for randomized controlled trials (RCTs) until 8 August 2019. The relative risk (RR), mean difference (MD) and 95% confidence intervals (CI) were determined. Results A total of six randomized controlled trials (RCTs) were included with 360 ARDS patients. The Meta analysis showed that the mean arterial pressure (MAP) in APRV group is higher than traditional mechanical ventilation group [MD = 2.35, 95% CI=(1.05,3.64), P = 0.0004], and the airway peak pressure (Ppeak) is lower in APRV group with statistical difference [MD=-2.04,95% CI=(-3.33,-0.75), P = 0.002]. However, no significant beneficial effect on oxygen index (PaO2/FiO2) was shown between two groups (MD = 26.24, 95% CI=(-26.50,78.97), P = 0.33). Compared with conventional mechanical ventilation, APRV significantly improved 28-day mortality [RR = 0.66, 95% CI=(0.47,0.94), P = 0.02]. Conclusions For critically ill patients with ARDS, application of APRV is associated with the increase of MAP, the reduction of the airway Ppeak and 28-day mortality, while there is no sufficient evidence to support the APRV is superior to conventional mechanical ventilation in PaO2/FiO2.

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

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Tommaso Pettenuzzo ◽  
Annalisa Boscolo ◽  
Alessandro De Cassai ◽  
Nicolò Sella ◽  
Francesco Zarantonello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Controlled Trials ◽  
Positive End Expiratory Pressure ◽  
Randomized Controlled

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.

scholarly journals Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

Neonatology ◽  
2021 ◽  
Vol 118 (3) ◽  
pp. 264-273
Author(s):  
Anne Lee Solevåg ◽  
Po-Yin Cheung ◽  
Georg M. Schmölzer
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Premature Infants ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

<b><i>Background:</i></b> Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) use pressure settings ≥ those used during mechanical ventilation (MV), and biphasic continuous positive airway pressure (BiPAP) use two nasal continuous positive airway pressure (NCPAP) levels ≤4 cm H<sub>2</sub>O apart. <b><i>Methods:</i></b> A systematic review (Medline OVID and Pubmed) and meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) and mortality. Secondary outcomes included NIV failure (intubation) and extubation failure (re-intubation). Data were pooled using a fixed-effects model to calculate the relative risk (RR) with 95% confidence interval (CI) between NIV modes (RevMan v 5.3, Copenhagen, Denmark). <b><i>Results:</i></b> Twenty-four randomized controlled trials that largely did not correct for mean airway pressure (MAP) and used outdated ventilators were included. Compared with NCPAP, both nsNIPPV and SNIPPV resulted in less re-intubation (RR 0.88 with 95% CI (0.80, 0.97) and RR 0.20 (0.10, 0.38), respectively) and BPD (RR 0.69 (0.49, 0.97) and RR 0.51 (0.29, 0.88), respectively). nsNIPPV also resulted in less intubation (RR 0.57 (0.45, 0.73) versus NCPAP, with no difference in mortality. One study showed less intubation in BiPAP versus NCPAP. <b><i>Conclusions:</i></b> Bi-level NIV versus NCPAP may reduce MV and BPD in premature infants with RDS. Studies comparing equivalent MAP utilizing currently available machines are needed.

scholarly journals Higher Versus Lower Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tommaso Pettenuzzo ◽  
Annalisa Boscolo ◽  
Alessandro De Cassai ◽  
Nicolò Sella ◽  
Francesco Zarantonello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Controlled Trials ◽  
Positive End Expiratory Pressure ◽  
Randomized Controlled ◽  
Duration Of Ventilation

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 December 18, 2020 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 or duration of ventilation in patients without ARDS receiving invasive mechanical ventilation, despite being associated with improved oxygenation and lower occurrence of ARDS.

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