Publication: Higher PEEP for acute respiratory distress syndrome: A Bayesian meta-analysis of randomised clinical trials
Issued Date
2021-06-01
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ISSN
26529335
14412772
14412772
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2-s2.0-85128445012
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Mahidol University
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SCOPUS
Bibliographic Citation
Critical Care and Resuscitation. Vol.23, No.2 (2021), 171-182
Suggested Citation
Ary Serpa Neto, George Tomlinson, Sarina K. Sahetya, Lorenzo Ball, Alistair D. Nichol, Carol Hodgson, Alexandre Biasi Cavalcanti, Matthias Briel, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz, Ewan C. Goligher Higher PEEP for acute respiratory distress syndrome: A Bayesian meta-analysis of randomised clinical trials. Critical Care and Resuscitation. Vol.23, No.2 (2021), 171-182. doi:10.51893/2021.2.oa4 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78125
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Title
Higher PEEP for acute respiratory distress syndrome: A Bayesian meta-analysis of randomised clinical trials
Other Contributor(s)
Universitätsklinikum Carl Gustav Carus Dresden
Institute of Health Policy, Management and Evaluation
IRCCS San Martino Polyclinic Hospital
McMaster University
University of Melbourne
Monash University
University of Toronto
Hospital Israelita Albert Einstein
Basel Institut für klinische Epidemiologie und Biostatistik
University Health Network University of Toronto
Mahidol University
Nuffield Department of Medicine
St Vincent's University Hospital
Universidade de São Paulo
The Alfred
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
Institute of Health Policy, Management and Evaluation
IRCCS San Martino Polyclinic Hospital
McMaster University
University of Melbourne
Monash University
University of Toronto
Hospital Israelita Albert Einstein
Basel Institut für klinische Epidemiologie und Biostatistik
University Health Network University of Toronto
Mahidol University
Nuffield Department of Medicine
St Vincent's University Hospital
Universidade de São Paulo
The Alfred
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
Abstract
Objective: Benefit or harm of higher positive end expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) is controversial. We aimed to assess the impact of higher levels of PEEP in patients with ARDS under a Bayesian framework. Design: Systematic review and Bayesian meta-analysis of randomised clinical trials comparing higher to lower PEEP in adult patients with ARDS. Data sources: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from 1996 to 1 March 2020. Review methods: We extracted data from high quality randomised clinical trials comparing higher to lower levels of PEEP in adult patients, using low tidal volume in both arms, and conducted a Bayesian meta-analysis using aggregate data from these studies. Results: Eight clinical trials including 3703 patients (n = 1833 for higher PEEP, n = 1870 for lower PEEP) were included. Under a minimally informative prior, the posterior probability of benefit with higher PEEP was 65% (relative risk, 0.97 [95% credible interval, 0.78-1.14]). In patients with moderate-tosevere ARDS, the posterior probability of benefit with higher PEEP was 77% (relative risk, 0.94 [95% credible interval, 0.77-1.13]). Down-weighting studies that employed a maximum recruitment strategy by 100% increased the posterior probability of benefit to 92% under a minimally informative prior. Conclusions: The probability of benefit or harm from routine use of higher PEEP for patients with ARDS ranges from 27% to 86%, and from 14% to 73% depending on one’s prior, suggesting continued uncertainty and equipoise regarding the benefit of PEEP. If data from trials using a maximum recruitment strategy is discounted to some extent because of uncertainty over the appropriateness of this approach, the available evidence suggests that higher PEEP could be beneficial for moderate-to-severe ARDS. However, well powered randomized clinical trials are needed to confirm these findings.