Higher PEEP compared to lower PEEP for ARDS
| Patient or population: adults with ARDS Settings: intensive care Intervention: higher PEEP Comparison: lower PEEP | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Lower PEEP | Higher PEEP | |||||
| Mortality (hospital) | 369 per 1000 | 332 per 1000 (299 to 373) | RR 0.90 (0.81 to 1.01) | 2299 (three studies) | +++- MODERATE Due to serious inconsistency | Different strategies used to set PEEP between trials |
| Mortality (28 day) | 330 per 1000 | 274 per 1000 (221 to 334) | RR 0.83 (0.67 to 1.01) | 1921 (five studies) | ++-- LOW Due to very serious inconsistency | Includes studies whose intervention compares high vs low tidal volume |
| Subgroup analysis in patients with moderate/severe ARDS (p/F<27 kPa) (subgroup analysis) Mortality (ICU) | 561 per 1000 | 377 per 1000 (270 to 534) | RR 0.67 (0.48 to 0.95) | 205 (three studies) | ++-- LOW Due to very serious inconsistency | Includes studies whose intervention compares high vs low tidal volume |
| Subgroup analysis in patients with moderate/severe ARDS (p/F<27 kPa) (individual patient data MA) Mortality (hospital) | 391 per 1000 | 352 per 1000 (317 to 319) | RR 0.90 (0.81 to 1) | 1892 (three studies) | +++- MODERATE Due to serious inconsistency | Different strategies used to set PEEP between trials |
| Subgroup analysis in patients with moderate / severe ARDS (P/f<200) (Individual patient data MA) Mortality (ICU up to day 60) | 366 per 1000 | 311 per 1000 (278 to 347) | RR 0.85 (0.76 to 0.95) | 1892 (three studies) | +++- MODERATE Due to serious inconsistency | Different strategies used to set PEEP between trials |
| Adverse event: barotrauma | 90 per 1000 | 87 per 1000 (59 to 127) | RR 0.97 (0.66 to 1.42) | 2504 (five studies) | +--- VERY LOW Due to very serious inconsistency and serious imprecision | Wide CI; 95% CI beyond 25% threshold |
| ICU free days | 781 | 751 | Mean difference 0.04 higher (1.03 lower to 1.1 higher) | +++- MODERATE Due to imprecision | Better indicated by lower value wide CI; 95% CI beyond 25% threshold | |
ARDS, acute respiratory distress syndrome; ICU, intensive care unit; PEEP, positive end-expiratory pressure.