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Ibarra‐Estrada, Miguel; Mireles-Cabodevila, Eduardo; García-Salas, Yessica; López-Pulgarín, José A; Chávez-Peña, Quetzalcóatl; García-Salcido, Roxana; Mijangos-Méndez, Julio C; Aguirre-Ávalos, Guadalupe

doi:10.1097/ccm.0000000000005458

Critical Care Medicine

2022

DOI: 10.1097/ccm.0000000000005458

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Miguel Ibarra‐Estrada

Eduardo Mireles-Cabodevila

Yessica García-Salas

et al.

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Cited by 2 publications

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“…Briefly, one of the main drawbacks in our study (2) was the reluctance of bedside clinicians to decrease the time on high pressure to less than 3 seconds, which led to a low mandatory minute ventilation and "transient" episodes of hypercapnia. We also clearly concluded that our results must be interpreted cautiously, as those were preliminary data and sample size was not reached (2,3).…”

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confidence: 73%

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Ibarra‐Estrada

Mireles-Cabodevila

García-Salas

et al. 2022

Critical Care Medicine

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confidence: 73%

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Ibarra‐Estrada

Mireles-Cabodevila

García-Salas

et al. 2022

Critical Care Medicine

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“…care unit. This condition mostly happened in patients with ARDS associated with severe COVID-193 .According to the findings from the research by Goligher, patients whose response to increased PEEP was followed by increased oxygenation, criteria were considered for study eligibility were described in Table…”

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confidence: 99%

Meta-Analysis of Higher PEEP Strategies' Effects on Mortality Rates and Inflammatory Mediators in Patients with ARDS: A Perspective Review on Patients with Severe COVID-19-Associated ARDS

Supranoto,

Negara

2023

Solo J. Anesth. Pain Critical Care

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Background: Different strategies of positive end-expiratory pressure (PEEP) in mechanical ventilation are crucial for patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). PEEP acts as a “double-edged sword” for ARDS patients. PEEP could recover pulmonary atelectasis but can induce alveolar hyperinflation.Objective: This review aimed to evaluate the effect of higher PEEP in patients with severe COVID-19-associated ARDS.Method: This meta-analysis included randomized controlled trial (RCT) studies to assess the mortality rates, barotrauma events, and inflammatory mediators modulation due to higher PEEP strategies. The pooled effect of the mortality rates and barotrauma events were presented as risk ratios (RR) with 95% confidence of interval (CI) using random-effects model (REM) or fixed-effects model (FEM).Results: We identified twelve RCTs comparing higher versus lower PEEP in ARDS patients. There was unsignificant result in overall mortality rates group [RR=0.94,95%CI(85,1.03),p=0.21] but not in mortality after positive response of oxygenation group [RR=0.88,95%CI(0.81,0.95),p=0.002] in higher PEEP group. In terms of patients without positive response of oxygenation, higher PEEP group had significantly higher mortality rates [RR=1.07,95%CI(1.00,1.15),p=0.06]. Higher PEEP significantly reduced the mortality rates in ARDS patients with PaO2/FiO2<150 mmHg [RR=0.867,95%CI(0.74,1.00),p=0.04] instead of patients with moderate ARDS (PaO2/FiO2 ≥150 mmHg) [RR=1.12, 95%CI(0.85,1.47), p=0.44]. There were no differences in overall barotrauma events [RR=1.03,95%CI(0.78,1.36),p=0.85] between higher and lower PEEP group. The use of higher and lower PEEP also contribute to the modulation of inflammatory mediators including TNF-α, IL-6, IL-1RA, and IL-8.Conclusion: Higher PEEP could reduce the mortality of patients with ARDS who responded to the oxygenation. Higher PEEP does not increase the risk of overall barotrauma events. Higher PEEP can modulate the inflammatory mediators.

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Cited by 2 publications

References 5 publications

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Meta-Analysis of Higher PEEP Strategies' Effects on Mortality Rates and Inflammatory Mediators in Patients with ARDS: A Perspective Review on Patients with Severe COVID-19-Associated ARDS

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