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Table 1 Characteristics of included studies

From: Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Study

Year

Type of patients

N

High PEEP group

Low PEEP group

Main findings

N

PEEP

V T

RM

DMV

N

PEEP

V T

RM

DMV

Surgical ICU patients

              

Lago Borges et al.

2014

Post-CG

136b

44

10

08

No

0.47

45

05

08

No

0.47

Shorter duration of ventilation with higher PEEP (considering only patients extubated within 12 h after ICU admission)

Lago Borges et al.

2013

Post-CG

136b

44

10

08

No

0.47

45

05

08

No

0.47

Higher compliance and less hypoxemia (P/F ratio < 300) with higher PEEP

Celebi et al.

2007

Post-CG

60a

20

10

07

Yes

0.25

20

05

07

No

0.25

Increase in P/F ratio (in the first 4 h but not after extubation) and less atelectasis with higher PEEP

Holland et al.

2007

Post-CG

28

14

10

6–8

No

0.08

14

05

6–8

No

0.08

No differences regarding cardiac index and filling pressures, liver function and gastric mucosal perfusion

Dyhr et al.

2002

Post-CG

16

08

15

06

Yes

NA

08

00

06

Yes

NA

Increase in P/F ratio and EELV (in the first 3 h) and less atelectasis with higher PEEP

Michalopoulos et al.

1996

Post-CG

67d

21

10

NA

No

NA

22

00

NA

No

NA

No differences regarding P/F ratio, duration of ventilation, and atelectasis

Carroll et al.

1988

Postsurgery P/F < 200

50

22

15

12

Yes

15

28

04

12

Yes

02

More hypotension, barotrauma, and death and higher duration of ventilation with higher PEEP

Marvel et al.

1986

Post-CG

44c

12

10

12

No

0.39

15

05

12

No

0.46

Lower alveolar–arterial oxygen tension gradient with higher PEEP (similar after extubation). No differences regarding atelectasis, and hospital length of stay

Murphy et al.

1983

Post-CG

139

NA

10

NA

No

0.33

NA

00

NA

No

0.33

No differences in blood loss independent of coagulation profile

Zurick et al.

1982

Post-CG

83

41

10

NA

No

NA

42

00

NA

No

NA

No differences regarding the amount of blood loss, need for re-exploration or blood requirement

Good et al.

1979

Post-CG

24

10

06

11

No

0.62

14

00

11

No

0.62

No differences regarding atelectasis, P/F ratio and arterial–alveolar ratio

Schmidt et al.

1976

Post-surgery risk of ARDS

112

56

08

12–15

No

NA

56

00

12–15

Yes

NA

Higher PaO2, alveolar–arterial oxygen tension, and lower incidence of ARDS and other pulmonary complications with higher PEEP

Medical

              

Ma et al.

2014

NPE

120

60

11–30

6–8

No

NA

60

3–10

6–8

No

NA

Lower 28-day mortality, EVLWi, PVPi, blood pressure and higher P/F ratio with high PEEP

Lesur et al.

2010

ARF

63

30

05

08

No

9.2

33

00

07

No

9.2

No differences regarding hypotension, duration of ventilation and mortality (PEEP used only during 90 min)

Manzano et al.

2008

Clinical P/F > 250

127

64

5–8

08

No

4.5

63

00

08

No

5.6

No differences regarding hospital mortality, ARDS, atelectasis or barotrauma. Lower incidence of VAP and hypoxemia with high PEEP

Vigil et al.

1996

Trauma

44

23

05

12

No

3.2

21

00

12

No

3.6

No differences regarding intrapulmonary shunt, dead space and P/F ratio

Cujec et al.

1993

ARF

46

NA

10

NA

No

NA

NA

00

NA

No

NA

Reduction in alveolar–arterial oxygen difference and shunt fraction with higher PEEP

Nelson et al.

1987

P/F < 250

38

20

15

NA

No

5.3

18

08

NA

No

3.4

No differences in duration of ventilation, ICU and hospital length of stay, barotrauma, and mortality

Pepe et al.

1984

Risk of ARDS

92

44

08

12

No

3.0

48

00

12

No

3.0

No differences regarding ARDS, barotrauma, atelectasis, mortality, duration of ventilation, ICU length of stay

Weigelt et al.

1979

Risk of ARDS

79

45

05

15

No

5.0

34

00

15

No

8.0

Lower incidence of ARDS, and pulmonary mortality and higher incidence of pulmonary dysfunction with higher PEEP

Feeley et al.

1975

ARF

25

12

05

10

No

NA

13

00

10

No

NA

Improve in vital capacity and the maximum inspiratory force and less increase in intra-pulmonary shunt with higher PEEP

  1. PEEP: positive end-expiratory pressure (in cmH2O); VT: tidal volume (in ml/kg); RM: recruitment maneuvers; DMV: duration of mechanical ventilation (in days); P/F: PaO2/FiO2; CG: cardiac surgery; NA: not available; EELV: end-expiratory lung volume; ARF: acute respiratory failure; NPE: neurologic pulmonary edema; EVLWi: extravascular lung water index; PVPi: pulmonary vascular permeability index; ARDS: acute respiratory distress syndrome; VAP: ventilator-associated pneumonia
  2. aOne group of 20 patients not included (use of CPAP only)
  3. bOne group of 47 patients not included (intermediate level of PEEP [8 cmH2O])
  4. c One group of 17 patients not included (exhaled to ambient pressure)
  5. d One group of 24 patients not included (intermediate level of PEEP [5 cmH2O])