Optimal Positive End Expiratory Pressure Levels in Ventilated Patients Without Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis and Systematic Review of Randomized Controlled Trials

Jing Zhou; Zhimin Lin; Xiumei Deng; Baiyun Liu; Yu Zhang; Yongxin Zheng; Haichong Zheng; Yingzhi Wang; Yan Lai; Weixiang Huang; Xiaoqing Liu; Weiqun He; Yuanda Xu; Yimin Li; Yongbo Huang; Ling Sang

doi:10.3389/fmed.2021.730018

Optimal Positive End Expiratory Pressure Levels in Ventilated Patients Without Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis and Systematic Review of Randomized Controlled Trials

Front Med (Lausanne). 2021 Sep 1:8:730018. doi: 10.3389/fmed.2021.730018. eCollection 2021.

Authors

Jing Zhou¹, Zhimin Lin¹, Xiumei Deng¹, Baiyun Liu¹, Yu Zhang¹, Yongxin Zheng¹, Haichong Zheng¹, Yingzhi Wang¹, Yan Lai¹, Weixiang Huang¹, Xiaoqing Liu¹, Weiqun He¹, Yuanda Xu¹, Yimin Li¹, Yongbo Huang¹, Ling Sang^{1

2}

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Guangzhou Laboratory, Guangdong, China.

Abstract

Background: To find the optimal positive end expiratory pressure (PEEP) in mechanical ventilated patients without Acute Respiratory Distress Syndrome (ARDS), we conducted a Bayesian network meta-analysis and systematic review of randomized controlled trials (RCTs) comparing different level of PEEP based on a novel classification of PEEP level: ZEEP group (PEEP = 0 cm H2O); lower PEEP group (PEEP = 1-6 cm H2O); intermediate PEEP group (PEEP = 7-10 cm H2O); higher PEEP group (PEEP > 10 cm H2O). Result: Twenty eight eligible studies with 2,712 patients were included. There were no significant differences in the duration of mechanical ventilation between higher and intermediate PEEP (MD: 0.020, 95% CI: -0.14, 0.28), higher and lower PEEP (MD: -0.010, 95% CI: -0.23, 0.22), higher PEEP and ZEEP (MD: 0.010, 95% CI: -0.40, 0.22), intermediate and lower PEEP (MD: -0.040, 95% CI: -0.18, 0.040), intermediate PEEP and ZEEP (MD: -0.010, 95% CI: -0.42, 0.10), lower PEEP and ZEEP (MD: 0.020, 95% CI: -0.32, 0.13), respectively. Higher PEEP was associated with significantly higher PaO2/FiO2 ratio(PFR) when compared to ZEEP (MD: 73.24, 95% CI: 11.03, 130.7), and higher incidence of pneumothorax when compared to intermediate PEEP, lower PEEP and ZEEP (OR: 2.91e + 12, 95% CI: 40.3, 1.76e + 39; OR: 1.85e + 12, 95% CI: 29.2, 1.18e + 39; and OR: 1.44e + 12, 95% CI: 16.9, 8.70e + 38, respectively). There was no association between PEEP levels and other secondary outcomes. Conclusion: We identified higher PEEP was associated with significantly higher PFR and higher incidence of pneumothorax. Nonetheless, in terms of other outcomes, no significant differences were detected among four levels of PEEP. Systematic Review Registration: The study had registered on an international prospective register of systematic reviews, PROSPERO, on 09 April 2021, identifier: [CRD42021241745].

Keywords: Acute respiratory distress syndrome; Mechanical ventilation; Mortality; Pneumothorax; Positive end expiratory pressure.

Publication types

Systematic Review