[High PEEP vs. conventional PEEP in the acute respiratory distress syndrome: a systematic review and meta-analysis].
OBJECTIVE
To perform a systematic review and meta-analysis of the literature to evaluate the effects of high PEEP versus conventional PEEP on mortality and on the risk of barotrauma in patients with the acute respiratory distress syndrome (ARDS).


METHODS
Computer search of Medline, Embase, CINAHL, CANCERLIT, Pascal-Biomed, ACP Journal Club, Cochrane library (CDSR, DARE, CCTR), ISI Proceedings, Current Contents, and Web of Science, as well as manual search of selected references.


METHODS
Controlled random clinical trials published after NAECC (1994) that evaluated the effect of two levels of PEEP and that reported the mortality and incidence of barotrauma in the series.


METHODS
By two investigators working independently, with discrepancies resolved by group consensus. Contingency tables were elaborated and the RRs with corresponding confidence intervals were obtained for each study.


RESULTS
Four articles were selected for the meta-analysis of mortality and three for the meta-analysis of barotrauma. No effects of PEEP level on mortality were found (RR 0.73, 95% CI: 0.49 to 1.10) or on the incidence of barotrauma (RR 0.50, 95% CI: 0.14 to 1.73). However, an analysis of the studies in which PEEP was individualized in function of Pflex showed a significant decrease in mortality (RR 0.59, 95% CI: 0.43 to 0.82) (p=0.001)


CONCLUSIONS
The use of high or conventional PEEP in function of oxygenation does not affect mortality or the incidence of barotrauma in patients with ARDS. However, there might be a decrease in mortality associated to high PEEP individualized in function of the pulmonary mechanics of each patient.
Gordo-Vidal
F
F
Unidad de Cuidados Intensivos, Fundación Hospital Alcorcón, Madrid, España. fgordo@fhalcorcon.es
Gómez-Tello
V
V
Palencia-Herrejón
E
E
Latour-Pérez
J
J
Sánchez-Artola
B
B
Díaz-Alersi
R
R
D006801:Humans; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*