Intervention
Population
Conclusion
- High PEEP (13 +/-3 cm H2O) vs. low PEEP (8 +/-3 cm H2O) set according to predetermined tables based on FiO2
- 549 patients with ARDS
- No significant difference in-hospital mortality between high PEEP and low PEEP groups (27.5% vs 24.9%, p = 0.48)
- Usual ventilation vs. open lung strategy (low volume ventilation, High PEEP, recruitment manoeuvres)
- 983 patients with ARDS across 30 ICUs worldwide
- Hospital mortality was similar between the 2 groups (Usual 40.4% vs open lung 36.4%, p=0.19.
- The open lung strategy had:
- Lower rates of refractory hypoxaemia (4.6% vs. 10.2%, p=0.01)
- Lower deaths with hypoxaemia (4.2% vs. 8.9%, P=0.3)
- Moderate PEEP (5-9cm H2O) vs. PEEP set to achieve plateau pressure 28-30 cm H2O
- 767 patients with ALI across 37 ICUs in France
- Hospital mortality was similar between the 2 groups (Low PEEP 31.2% vs High PEEP 27.8%, p=0.31
- Higher PEEP group had a higher number of ventilator-free days (7 vs. 3, p=0.04
- ARDSnet protocol vs. open lung approach
- 1,874 patients with ARDS across 20 ICUs
- Open lung group had improved oxygenation at 24-72 hours
- No difference in:
- ICU mortality (25% vs. 30%, p=0.53)
- Ventilator free days (8 vs. 7, p=0.53)
- Conventional ventilation vs. use of recruitment manoeuvre and PEEP titration based on compliance
- 1010 patients with ARDS across 120 ICUs worldwide
- Titrated PEEP group demonstrated:
- Increased 6-month mortality (65.3% vs. 59.9%, p=0.04)
- Decreased ventilator-free days (5.3 vs 6.4, p=0.03)
- No difference in ICU LOS or hospital mortality
- Conventional ventilation vs. open lung strategy
- 15 RCTs involving 3,134 patients
- Open lung strategy:
- Improves hospital mortality (RR 0.88, p=0.009)
- Improves ICU mortality (RR0.77, p=0.033)