Lower tidal volume compared with higher tidal volume (at similar PEEP) for ARDS
| Patient or population: adults with ARDS Settings: intensive care Intervention: lower tidal volume Comparison: higher, conventional tidal volume | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Higher tidal volume | Lower tidal volume | |||||
| Mortality (60 day) | 379 per 1000 | 467 per 1000 (303 to 717) | RR 1.23 (0.8 to 1.89) | 116 (one study) | ++-- LOW Due to inconsistency and imprecision | |
| Mortality (hospital) | 408 per 1000 | 338 per 1000 (290 to 400) | RR 0.83 (0.71 to 0.98) | 1033 (three studies) | +++- MODERATE Due to serious indirectness | |
| Adverse event: barotrauma | 30 per 1000 | 35 per 1000 (19 to 65) | RR 1.17 0.63 to 2.18 | 1149 (four studies) | +++- MODERATE Due to serious indirectness | |
| Lower tidal volume and higher PEEP compared with higher tidal volume and lower PEEP for ARDS | ||||||
| Patient or population: adults with ARDS Settings: intensive care Intervention: lower tidal volume and higher PEEP (LV/PEEP) Comparison: higher tidal volume and lower PEEP (HV/PEEP) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Low PEEP/ HIGH TV | High PEEP/ Low TV | |||||
| Mortality (ICU) | 594 per 1000 | 339 per 1000 (238 to 487) | RR 0.57 (0.4 to 0.82) | 148 (two studies) | ++-- LOW Due to inconsistency and imprecision | ARDS Net ARMA study control group had higher TVs (11.5/12) than controls in the other four studies |
| Mortality (28 day) | 708 per 1000 | 383 per 1000 (220 to 645) | RR 0.54 (0.31 to 0.91) | 53 (one study) | ++-- LOW Due to inconsistency and imprecision | |
| Mortality (hospital) | 609 per 1000 | 377 per 1000 (268 to 530) | RR 0.62 (0.44 to 0.87) | 148 (two studies) | ++-- LOW Due to inconsistency and imprecision | |
| Adverse events: nosocomial pneumonia | 458 per 1000 | 587 per 1000 (344 to 999) | RR 1.28 (0.75 to 2.18) | 53 (one study) | ++-- LOW Due to inconsistency and imprecision | |
| Adverse events | 214 per 1000 | 165 per 1000 (105 to 261) | RR 0.77 (0.49 to 1.22) | 254 (two studies) | ++-- LOW Due to inconsistency and imprecision | |
ARDS, acute respiratory distress syndrome; ICU, intensive care unit; PEEP, positive end-expiratory pressure.