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

Serpa Neto, Ary; Filho, Roberto Rabello; Cherpanath, Thomas; Determann, Rogier; Dongelmans, Dave A.; Paulus, Frederique; Tuinman, Pieter Roel; Pelosi, Paolo; de Abreu, Marcelo Gama; Schultz, Marcus J.

doi:10.1186/s13613-016-0208-7

Annals of Intensive Care

Table 2 Summary of stratified analyses of pooled risk ratios

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

Stratified analysis	No. of trials	No. of patients^a	Risk ratio (95% CI) SMD (95% CI)	p value	I ² (p value)
In-hospital mortality
Level of PEEP
High PEEP versus ZEEP	5	404	0.83 (0.62–1.11)	0.20	0% (0.57)
Type of patient
Medical patients	5	399	0.82 (0.62–1.09)	0.17	0% (0.73)
Level of PEEP
≥10 Versus <10 cmH₂O	3	131	2.04 (0.19–21.85)	0.56	77% (0.04)
28-Day mortality
Level of PEEP
High PEEP versus ZEEP	1	63	0.82 (0.47–1.45)	0.50	NA
Type of patient
Medical patients	2	183	0.55 (0.26–1.18)	0.12	76% (0.04)
Level of PEEP
≥10 versus <10 cmH₂O	1	120	0.38 (0.24–0.62)	<0.001	NA
Duration of ventilation
Level of PEEP
High PEEP versus ZEEP	2	87	0.89 (−0.95–2.73)	0.34	91% (< 0.01)
Type of patient
Medical patients	2	101	0.17 (−0.25–0.60)	0.43	13% (0.28)
Level of PEEP
≥10 versus <10 cmH₂O	1	38	0.45 (−0.20–1.09)	0.18	NA
ARDS
Level of PEEP
High PEEP versus ZEEP	4	410	0.43 (0.21–0.91)	0.03	56% (0.08)
Type of patient
Medical patients	3	298	0.52 (0.27–1.02)	0.06	50% (0.13)
Level of PEEP
≥10 versus <10 cmH₂O	0	0	NA	NA	NA
Pneumonia
Level of PEEP
High PEEP versus ZEEP	3	331	0.58 (0.29–1.15)	0.12	58% (0.09)
Type of patient
Medical patients	2	219	0.64 (0.24–1.66)	0.36	72% (0.06)
Level of PEEP
≥10 versus <10 cmH₂O	0	0	NA	NA	NA
Atelectasis
Level of PEEP
High PEEP versus ZEEP	3	331	0.74 (0.33–1.66)	0.46	74% (0.02)
Type of patient
Medical patients	2	219	1.00 (0.54–1.84)	0.99	63% (0.10)
Level of PEEP
≥10 versus <10 cmH₂O	0	0	NA	NA	NA
Barotrauma
Level of PEEP
High PEEP versus ZEEP	4	374	0.60 (0.13–2.70)	0.50	52% (0.15)
Type of patient
Medical patients	3	257	0.79 (0.28–2.27)	0.67	22% (0.28)
Level of PEEP
≥10 versus <10 cmH₂O	4	203	6.26 (0.78–50.47)	0.09	0% (0.46)
PaO ₂ /FiO ₂ ratio
Level of PEEP
High PEEP versus ZEEP	2	143	0.63 (0.29–0.96)	< 0.01	0% (0.79)
Type of patient
Medical patients	2	247	1.17 (0.06–2.28)	0.04	94% (< 0.01)
Level of PEEP
≥10 versus <10 cmH₂O	4	253	0.74 (−0.14–1.61)	0.10	89% (< 0.01)
Hypoxemia
Level of PEEP
High PEEP versus ZEEP	2	170	0.42 (0.19–0.92)	0.03	19% (0.27)
Type of patient
Medical patients	1	127	0.35 (0.20–0.61)	< 0.01	NA
Level of PEEP
≥10 versus <10 cmH₂O	1	43	1.05 (0.16–6.77)	0.96	NA
Blood pressure
Level of PEEP
High PEEP versus ZEEP	NA	NA	NA	NA	NA
Type of patient
Medical patients	1	120	−0.92 (−1.30 to –0.54)	< 0.01	NA
Level of PEEP
≥10 versus <10 cmH₂O	2	158	−0.21 (−1.68 to 1.26)	0.78	92% (< 0.01)
Hypotension
Level of PEEP
High PEEP versus ZEEP	1	63	1.10 (0.68–1.79)	0.70	NA
Type of patient
Medical patients	1	63	1.10 (0.68–1.79)	0.70	NA
Level of PEEP
≥10 versus <10 cmH₂O	1	82	32.16 (2.04–507.16)	0.01	NA

CI confidence interval, SMD standardized mean difference, ICU intensive care unit, PEEP positive end-expiratory pressure, ZEEP zero positive end-expiratory pressure, ARDS acute respiratory distress syndrome, NA not applicable
^aConsidering the studies included in each subgroup analysis

Back to article page