Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis

Cui, Yu; Cao, Rong; Wang, Yu; Li, Gen

doi:10.1159/000501045

Cited by 33 publications

(22 citation statements)

References 27 publications

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“…Lung recruitment maneuvers do not significantly reduce mortality but may improve oxygenation and shorten the length of hospital stay in ARDS patients. 42 Overall, recruitment maneuvers are not supported by high-quality evidence, 43 and caution should be exercised when using it because it can be irritating, incite coughing, and generate aerosols.…”

Section: Ventilation Managementmentioning

confidence: 99%

Intubation and Ventilation amid the COVID-19 Outbreak

et al. 2020

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The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.

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Section: Ventilation Managementmentioning

confidence: 99%

Intubation and Ventilation amid the COVID-19 Outbreak

et al. 2020

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“…Nevertheless, some new clinical trials sound promising such as the use of higher positive end-expiratory pressure (Dries, 2019 ). It has also been shown that lung recruitment maneuvers may improve the oxygenation process and shorten the hospital stay period in ARDS (Cui et al., 2020 ) and avoid the pro-inflammatory processes triggered by mechanical ventilation (Spadaro et al., 2019 ) . Because in ARDS, the lung injury is accompanied with an acute onset, the recognition and the determination of the respiratory damage threshold would certainly be a key point for a better and efficient ARDS therapy (Dries, 2019 ).…”

Section: Management and Treatment Strategies Of Ards Associated Sars-mentioning

confidence: 99%

Acute respiratory distress syndrome: a life threatening associated complication of SARS-CoV-2 infection inducing COVID-19

Badraoui

Alrashedi

Elmay

et al. 2020

Journal of Biomolecular Structure and Dynamics

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Acute Respiratory Distress Syndrome (ARDS) is a form of respiratory failure in human. The number of deaths caused by SARS-CoV-2 infection inducing this severe pneumonia (ARDS) is relatively high. In fact, COVID-19 might get worsen in ARDS and provoke respiratory failure. A better understood of ARDS key features and the pathophysiological injuries of the pulmonary parenchyma are linked to lessons learned from previous severe diseases associated previous coronaviruses outbreaks (especially SARS-CoV and MERS-CoV) and more the ongoing SARS-CoV-2. The ARDS mechanism includes a diffuse alveolar damage associated disruption of alveolar capillary membrane, pulmonary edema, damaged endothelium and increased permeability. A diffuse inflammation, with acute onset, on the lung tissue accompanied by release of biochemical signal and inflammatory mediators (TNFa, IL-1 and IL-6) leading to hypoxemia, low PaO 2 /FiO 2 ratio and the chest radiological expression of bilateral infiltrates in ARDS. The ongoing outbreak could lead to a better understood of ARDS pathophysiology and prognostic. An overview is also highlighted about the seven coronaviruses proved to infect human especially those having ability to cause severe disease SARS-CoV, MERS-CoV and SARS-CoV-2. In this review, we focused on the major pathological mechanisms leading to the ARDS development as a result of viral infection, severe COVID-19 worsening.

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“…that the total amount of lung recruitment tissue increased with ARDS severity [33]. A recent two pairwise meta-analysis suggested that RM had no advantageous effect on mortality [13,34]. Higher PEEP reduced mortality in the subgroup for patients with ARDS who responded to increased PEEP by improved oxygenation; overall, higher PEEP was not an advantageous for patients with ARDS [11].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of different mechanical ventilation strategies for patients with acute respiratory distress syndrome: Systematic review and network meta-analysis

Huang

Wang

Jia

et al. 2020

Preprint

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Background: Acute respiratory distress syndrome (ARDS) leads to life-threatening acute hypoxemic respiratory failure in clinic and usually requires mechanical ventilation. Low tidal volume ventilation is now universally accepted as management treatment for this condition. However, recruitment maneuvers (RM) and positive end-expiratory pressure (PEEP) remain controversial. Therefore, we performed a network meta-analysis to identify the RM and PEEP levels of patients with ARDS.Methods: We searched PubMed, OVID, Embase, and the Cochrane Central Register of Controlled Trials (Central) databases. The primary outcome was death in the 28th day, and the secondary outcomes included death in hospital, ventilator-free days, and barotrauma. Data for study characteristics, methods, and outcomes were extracted. The relative effect sizes were estimated by risk ratios (RRs) for binary variables and standard mean difference (SMD) for continuous variables. Relative ranking of the interventions was conducted using surface under the cumulative ranking. Multiple intervention comparisons based on the Bayesian and frequentist frameworks were performed to integrate the efficacy of all included strategies.Results: Thirty randomized controlled trials comprising 4410 patients were included in the network meta-analysis. None of the ventilation strategies was significantly superior over others for all outcomes. According to the relative rank probabilities, low PEEP showed the lowest probability of harming death in the 28th day, whereas RM+low PEEP showed the highest probability of benefitting death in hospital and ventilator-free days. Low PEEP showed the highest probability of benefitting barotrauma. The overall quality of the evidence per grade was moderate to low.Conclusions: No ventilation strategy is significantly superior over others. RM+low PEEP has the highest probability of benefitting survival. The evidence has low overall quality and should be further studied.

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Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis

Cited by 33 publications

References 27 publications

Intubation and Ventilation amid the COVID-19 Outbreak

Intubation and Ventilation amid the COVID-19 Outbreak

Acute respiratory distress syndrome: a life threatening associated complication of SARS-CoV-2 infection inducing COVID-19

Efficacy and safety of different mechanical ventilation strategies for patients with acute respiratory distress syndrome: Systematic review and network meta-analysis

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