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Annals of Intensive Care

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])
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