Prophylactic Positive End‐Expiratory Pressure and Postintubation Hemodynamics: An Interventional, Randomized Study

Lesur, Olivier; Rémillard, Marie-Anaïs; St-Pierre, Catherine; Falardeau, Simon

doi:10.1155/2010/269581

Cited by 14 publications

(19 citation statements)

References 21 publications

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“…Although there were no differences in the amount of atelectasis in the patients undergoing general anesthesia without lung injury between a tidal volume of 10 and 6 ml/kg [ 5 ], in patients with acute lung injury, changes in tidal volume from 10 to 6 ml/kg increase the alveolar collapse, which can reversed by positive end-expiratory pressure (PEEP) application [ 6 ]. Applying PEEP in addition to controlled ventilation has been suggested to increase functional residual capacity and alveolar recruitment and to improve oxygenation and ventilation/perfusion mismatching under endotracheal intubation or when a ProSeal LMA is used [ 7 – 9 ]. However, because of the absence of an inflatable cuff, theoretically the i-gel might be more likely to have gas leaks during positive pressure ventilation than other supraglottic airway devices [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients

et al. 2013

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PurposeThis prospective, randomized trial was designed to assess whether the i-gel supraglottic airway device is suitable for volume-controlled ventilation while applying positive end-expiratory pressure (PEEP) of 5 cmH2O under general anesthesia. It was believed that this device might improve arterial oxygenation.MethodsForty adult patients (aged 20–60 years) scheduled for elective orthopedic surgery were enrolled in this study. Twenty patients were ventilated without external PEEP [zero positive end-expiratory pressure (ZEEP) group], and the other 20 were ventilated with PEEP 5 cmH2O (PEEP group) after placing an i-gel device. Volume-controlled ventilation at a tidal volume (TV) of 8 ml/kg of ideal body weight, leak volume, and arterial blood gas analysis were investigated.ResultsThe incidences of a significant leak were similar in the ZEEP and PEEP groups (3/20 and 1/20, respectively; P = 0.605), as were leak volumes. No significant PaO2 difference was observed between the two groups at 1 h after satisfactory i-gel insertion (215 ± 38 vs. 222 ± 54; P = 0.502).ConclusionsThe use of an i-gel during PEEP application at 5 cmH2O did not increase the incidence of a significant air leak, and a PEEP of 5 cmH2O failed to improve arterial oxygenation during controlled ventilation in healthy adult patients.

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Section: Introductionmentioning

confidence: 99%

Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients

et al. 2013

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“…After screening the abstracts, 99 articles were eligible for the full-text review process. Ultimately, the literature pieces were subsequently refined to 27 eligible RCTs involving a total of 2980 participants for further consideration [ 8 , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ]. The eligible studies recruited in this study were performed between 1975 and 2020.…”

Section: Resultsmentioning

confidence: 99%

Effect of different levels of PEEP on mortality in ICU patients without acute respiratory distress syndrome: systematic review and meta-analysis with trial sequential analysis

Shao

Kang

Qian

et al. 2021

Journal of Critical Care

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Objective To determine whether higher positive end- expiratory pressure (PEEP) could provide a survival advantage for patients without acute respiratory distress syndrome (ARDS) compared with lower PEEP. Methods Eligible studies were identified through searches of Embase, Cochrane Library, Web of Science, Medline, and Wanfang database from inception up to 1 June 2021. Trial sequential analysis (TSA) was used in this meta-analysis. Data synthesis Twenty-seven randomized controlled trials (RCTs) were identified for further evaluation. Higher and lower PEEP arms included 1330 patients and 1650 patients, respectively. A mean level of 9.6±3.4 cmH 2 O was applied in the higher PEEP groups and 1.9±2.6 cmH 2 O was used in the lower PEEP groups. Higher PEEP, compared with lower PEEP, was not associated with reduction of all-cause mortality (RR 1.03; 95% CI 0.91–1.18; P =0.627), and 28-day mortality (RR 1.07 ; 95% CI 0.92–1.24; P =0.365). In terms of risk of ARDS (RR 0.43; 95% CI 0.24–0.78; P =0.005), duration of intensive care unit (MD -1.04; 95%CI-1.36 to −0.73; P < 0.00001), and oxygenation (MD 40.30; 95%CI 0.94 to 79.65; P = 0.045), higher PEEP was superior to lower PEEP. Besides, the pooled analysis showed no significant differences between groups both in the duration of mechanical ventilation (MD 0.00; 95%CI-0.13 to 0.13; P = 0.996) and hospital stay (MD -0.66; 95%CI-1.94 to 0.61; P = 0.309). More importantly, lower PEEP did not increase the risk of pneumonia, atelectasis, barotrauma, hypoxemia, or hypotension among patients compared with higher PEEP. The TSA analysis showed that the results of all-cause mortality and 28-day mortality might be false-negative results. Conclusions Our results suggest that a lower PEEP ventilation strategy was non-inferior to a higher PEEP ventilation strategy in ICU patients without ARDS, with no increased risk of all-cause mortality and 28-day mortality. Further high-quality RCTs should be performed to confirm these findings.

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“…After carefully reading the full text of the remaining 63 articles, we found 39 of them inappropriate for the following reasons: 1) not ICU patients (n = 3); 2) disequilibrium of other ventilation parameters (n = 7); 3) not RCT (n = 3); 4) animal trials (n = 2); 5) receiving different PEEP within single patients (n = 15); 6) including patients with ARDS or age under 18 (n = 2); 7) retrospective studies (n = 4); 8) intraoperative studies (n = 2) and 9) full article unavailable. Therefore, we nally analyzed 24 studies [5,8,[10][11][12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] .…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

“…Among studies presented in Table 1, high PEEP groups applied PEEP ranging from 5 to 30 cm H 2 O, while the range of PEEP in low PEEP groups was from 0 to 10 cm H 2 O. Ten studies used ZEEP (de ned as 0 cm H 2 O PEEP) as comparative group and most of them published earlier [8,12,19,[21][22][23][24][25][26]31] . Patients in ICU requiring PEEP were either medical ones (including ARF, trauma, NPE, etc.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Higher PEEP versus Lower PEEP Strategies for Patients in ICU without Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Mao

et al. 2021

Preprint

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Background: The application of high PEEP remains to be a controversial issue when it comes to ICU patients underwent ventilation. There are studies supporting the usage of high PEEP in patients with ARDS, while for those without ARDS, the conclusion is of great ambiguity. We performed this systematic review and meta-analysis to compare the effects of high and low level of PEEP on ICU patients without ARDS.Methods: We searched public databases (including PubMed, EMBASE, Cochrane Library and Clinicaltrial.gov) to find eligible randomized controlled trials (RCTs). The primary outcomes included in this meta-analysis were in-hospital mortality, 28-day mortality and the duration of ventilation, ICU stay, and hospital stay. We used the Cochrane risk of bias assessment tool to evaluate risk of bias. Trial Sequential Analysis (TSA) was conducted. Results: We included 2307 patients from 24 trials using high and low PEEP. Although no significant difference was found between high and low PEEP applications in in-hospital mortality (risk ratio[RR] 0.98, 95% confidence interval[CI] [0.81, 1.19], P=0.87), 28-day mortality (RR 0.68, 95% CI [0.33, 1.40], P=0.30) and the duration of ventilation (mean difference[MD] -0.30, 95% CI [-0.64, 0.04], P=0.09), ICU stay (MD -0.38, 95% CI [-1.03, 0.27], P=0.25), and hospital stay (MD -0.56, 95% CI [-1.44, 0.32], P=0.22), high PEEP indeed increased the level of PaO2/FIO2 (MD 32.39, 95% CI [13.06, 51.72], P=0.001), and therefore decreased the incidences of ARDS (RR 0.57, 95% CI [0.37, 0.89], P=0.01) and hypoxaemia (RR 0.60, 95% CI [0.41, 0.88], P=0.009). In addition, although total results did not reveal the advantage of high PEEP on other secondary outcomes regarding atelectasis, barotrauma, ventilator associated pneumonia (VAP), hypotension, mean arterial pressure (MAP), SaO2 and lactate, subgroup analysis seemed to obtain different results. The TSA results suggested more RCTs were needed. Conclusion: Ventilation with high PEEP in ICU patients without ARDS may improve the level of oxygenation (PaO2/FIO2) resulting in low incidences of ARDS and hypoxaemia. Nevertheless, other clinical outcomes including in-hospital and 28-day mortality, duration of ventilation, ICU stay and hospital stay, pulmonary complications, hemodynamics and post-operative fluid balance did not show any significant difference.

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Prophylactic Positive End‐Expiratory Pressure and Postintubation Hemodynamics: An Interventional, Randomized Study

Abstract: In the present trial, there was no evidence that implementing a prophylactic PEEP of 5 cmH2O adversely affects short-term hemodynamics or outcome in medical intensive care patients during the postintubation period.

Cited by 14 publications

References 21 publications

Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients

Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients

Effect of different levels of PEEP on mortality in ICU patients without acute respiratory distress syndrome: systematic review and meta-analysis with trial sequential analysis

Higher PEEP versus Lower PEEP Strategies for Patients in ICU without Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

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