The Effect of the Pressure–Volume Curve for Positive End-Expiratory Pressure Titration on Clinical Outcomes in Acute Respiratory Distress Syndrome-Reference-Cited by-同舟云学术

The Effect of the Pressure–Volume Curve for Positive End-Expiratory Pressure Titration on Clinical Outcomes in Acute Respiratory Distress Syndrome

Published:2013-07-11 Issue:6 Volume:29 Page:348-356
ISSN:0885-0666
Container-title:Journal of Intensive Care Medicine
language:en
Short-container-title:J Intensive Care Med

Author:

Hata J. Steven¹²³⁴,Togashi Kei⁵,Kumar Avinash B.⁶,Hodges Linda D.⁷,Kaiser Eric F.⁸,Tessmann Paul B.⁹,Faust Christopher A.¹⁰,Sessler Daniel I.¹¹

Affiliation:

1. Departments of Outcomes Research, Cardiac Anesthesiology, and General Anesthesiology, Center for Critical Care, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

2. Department of Cardiac Anesthesiology, Center for Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA

3. Department of General Anesthesiology, Center for Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA

4. Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

5. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

6. Division of Critical Care in the Department of Anesthesia, University of Vanderbilt, Nashville, TN, USA

7. Imperial Drive, O'Fallon, MO, USA

8. Department of Cardiac Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

9. Division of Cardiothoracic Surgery, University of Florida; Gainesville, FL, USA

10. Department of Anesthesiology, University of Iowa, Iowa City, IA, USA

11. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

Abstract

Purpose Methods to optimize positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remain controversial despite decades of research. The pressure–volume curve (PVC), a graphical ventilator relationship, has been proposed for prescription of PEEP in ARDS. Whether the use of PVC’s improves survival remains unclear. Methods In this systematic review, we assessed randomized controlled trials (RCTs) comparing PVC-guided treatment with conventional PEEP management on survival in ARDS based on the search of the National Library of Medicine from January 1, 1960, to January 1, 2010, and the Cochrane Central Register of Controlled Trials. Three RCTs were identified with a total of 185 patients, 97 with PVC-guided treatment and 88 with conventional PEEP management. Results The PVC-guided PEEP was associated with an increased probability of 28-day or hospital survival (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.5, 4.9) using a random-effects model without significant heterogeneity ( I2 test: P = .75). The PVC-guided ventilator support was associated with reduced cumulative risk of mortality (−0.24 (95% CI −0.38, −0.11). The PVC-managed patients received greater PEEP (standardized mean difference [SMD] 5.7 cm H2O, 95% CI 2.4, 9.0) and lower plateau pressures (SMD −1.2 cm H2O, 95% CI −2.2, −0.2), albeit with greater hypercapnia with increased arterial pCO2 (SMD 8 mm Hg, 95% CI 2, 14). Weight-adjusted tidal volumes were significantly lower in PVC-guided than conventional ventilator management (SMD 2.6 mL/kg, 95% CI −3.3, −2.0). Conclusion This analysis supports an association that ventilator management guided by the PVC for PEEP management may augment survival in ARDS. Nonetheless, only 3 randomized trials have addressed the question, and the total number of patients remains low. Further outcomes studies appear required for the validation of this methodology.

Publisher

SAGE Publications

Subject

Critical Care and Intensive Care Medicine

Link

http://journals.sagepub.com/doi/pdf/10.1177/0885066613488747

Reference33 articles.

1. Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation.

2. Effects of Positive End-expiratory Pressure on the Canine Venous Return Curve

3. Hemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: Importance of the volume status*

4. Airway Pressures and Early Barotrauma in Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

Cited by 12 articles. 订阅此论文施引文献订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献

1. Conventional Mechanical Ventilation in Acute Respiratory Failure;Personalized Mechanical Ventilation;2022

2. Measurement of Electrical Impedance Tomography-Based Regional Ventilation Delay for Individualized Titration of End-Expiratory Pressure;Journal of Clinical Medicine;2021-06-30

3. Electrical Impedance Tomography for Optimal Positive End-Expiratory Pressure in the ICU and Goal-Directed Support*;Critical Care Medicine;2021-05-20

4. Management of ARDS: From ventilation strategies to intelligent technical support – Connecting the dots;Trends in Anaesthesia and Critical Care;2020-10

5. The use of positive end expiratory pressure in patients affected by COVID-19: Time to reconsider the relation between morphology and physiology;Best Practice & Research Clinical Anaesthesiology;2020-09