Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.

<h4>Background</h4>Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life threatening clinical conditions seen in critically ill patients with diverse underlying illnesses. Lung injury may be perpetuated by ventilation strategies that do not limit lung volumes an...

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Autores principales:	Karen E A Burns, Neill K J Adhikari, Arthur S Slutsky, Gordon H Guyatt, Jesus Villar, Haibo Zhang, Qi Zhou, Deborah J Cook, Thomas E Stewart, Maureen O Meade
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f60efb3f3e3c4f769234bdf690e69d27
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spelling	oai:doaj.org-article:f60efb3f3e3c4f769234bdf690e69d272021-12-02T20:11:47ZPressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0014623https://doaj.org/article/f60efb3f3e3c4f769234bdf690e69d272011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21298026/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life threatening clinical conditions seen in critically ill patients with diverse underlying illnesses. Lung injury may be perpetuated by ventilation strategies that do not limit lung volumes and airway pressures. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pressure and volume-limited (PVL) ventilation strategies with more traditional mechanical ventilation in adults with ALI and ARDS.<h4>Methods and findings</h4>We searched Medline, EMBASE, HEALTHSTAR and CENTRAL, related articles on PubMed™, conference proceedings and bibliographies of identified articles for randomized trials comparing PVL ventilation with traditional approaches to ventilation in critically ill adults with ALI and ARDS. Two reviewers independently selected trials, assessed trial quality, and abstracted data. We identified ten trials (n = 1,749) meeting study inclusion criteria. Tidal volumes achieved in control groups were at the lower end of the traditional range of 10-15 mL/kg. We found a clinically important but borderline statistically significant reduction in hospital mortality with PVL [relative risk (RR) 0.84; 95% CI 0.70, 1.00; p = 0.05]. This reduction in risk was attenuated (RR 0.90; 95% CI 0.74, 1.09, p = 0.27) in a sensitivity analysis which excluded 2 trials that combined PVL with open-lung strategies and stopped early for benefit. We found no effect of PVL on barotrauma; however, use of paralytic agents increased significantly with PVL (RR 1.37; 95% CI, 1.04, 1.82; p = 0.03).<h4>Conclusions</h4>This systematic review suggests that PVL strategies for mechanical ventilation in ALI and ARDS reduce mortality and are associated with increased use of paralytic agents.Karen E A BurnsNeill K J AdhikariArthur S SlutskyGordon H GuyattJesus VillarHaibo ZhangQi ZhouDeborah J CookThomas E StewartMaureen O MeadePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 1, p e14623 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Karen E A Burns Neill K J Adhikari Arthur S Slutsky Gordon H Guyatt Jesus Villar Haibo Zhang Qi Zhou Deborah J Cook Thomas E Stewart Maureen O Meade Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
description	<h4>Background</h4>Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life threatening clinical conditions seen in critically ill patients with diverse underlying illnesses. Lung injury may be perpetuated by ventilation strategies that do not limit lung volumes and airway pressures. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pressure and volume-limited (PVL) ventilation strategies with more traditional mechanical ventilation in adults with ALI and ARDS.<h4>Methods and findings</h4>We searched Medline, EMBASE, HEALTHSTAR and CENTRAL, related articles on PubMed™, conference proceedings and bibliographies of identified articles for randomized trials comparing PVL ventilation with traditional approaches to ventilation in critically ill adults with ALI and ARDS. Two reviewers independently selected trials, assessed trial quality, and abstracted data. We identified ten trials (n = 1,749) meeting study inclusion criteria. Tidal volumes achieved in control groups were at the lower end of the traditional range of 10-15 mL/kg. We found a clinically important but borderline statistically significant reduction in hospital mortality with PVL [relative risk (RR) 0.84; 95% CI 0.70, 1.00; p = 0.05]. This reduction in risk was attenuated (RR 0.90; 95% CI 0.74, 1.09, p = 0.27) in a sensitivity analysis which excluded 2 trials that combined PVL with open-lung strategies and stopped early for benefit. We found no effect of PVL on barotrauma; however, use of paralytic agents increased significantly with PVL (RR 1.37; 95% CI, 1.04, 1.82; p = 0.03).<h4>Conclusions</h4>This systematic review suggests that PVL strategies for mechanical ventilation in ALI and ARDS reduce mortality and are associated with increased use of paralytic agents.
format	article
author	Karen E A Burns Neill K J Adhikari Arthur S Slutsky Gordon H Guyatt Jesus Villar Haibo Zhang Qi Zhou Deborah J Cook Thomas E Stewart Maureen O Meade
author_facet	Karen E A Burns Neill K J Adhikari Arthur S Slutsky Gordon H Guyatt Jesus Villar Haibo Zhang Qi Zhou Deborah J Cook Thomas E Stewart Maureen O Meade
author_sort	Karen E A Burns
title	Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
title_short	Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
title_full	Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
title_fullStr	Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
title_full_unstemmed	Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
title_sort	pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/f60efb3f3e3c4f769234bdf690e69d27
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Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.

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