title: Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.
abstract: To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.|Department of critical care medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Changsong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.|Department of Anesthesiology, JILIN GUO WEN Hospital, Gongzhuling, China.
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Chunjie
authors.initials: C
authors.lastname: Chi
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Libo
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Nana
authors.initials: N
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Pi
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Ailing
authors.initials: A
authors.lastname: Lian
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Jinghui
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Enyou
authors.initials: E
authors.lastname: Li
mesh_terms: D006801:Humans; D008168:Lung / Q000503:physiopathology*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D012129:Respiratory Function Tests; D014691:Ventilation