by Tommaso Pettenuzzo, Annalisa Boscolo, Alessandro De
Cassai, Nicolò Sella, Francesco Zarantonello, Paolo Persona, Laura Pasin,
Giovanni Landoni and Paolo Navalesi
Critical Care volume 25,
Article number: 247, Published: 15
July 2021
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.
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