Table 2. Characteristics of randomized controlled trials of twenty-six ventilation strategies for ARDS.
| Source | Ventilation strategies | Jadadscale | No. of Patients | Age(y)Mean ± SD | Oxygenation index(mmHg) Mean ± SD | Diagnosis | Result |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | Length ofmechanical ventilation (d) Mean ± SD | ICU length of stay (d) Mean ± SD | Barotrauma(n) | Hospital Lengthof stay (d)Mean ± SD | |||||||
| Amatoet al.49 | HVT + FiO2−LPEEP vs. HVT + FiO2−LPEEP | 6 | 53 | 33 ± 13/36 ± 14 | 112/134a | ARDS | *Death In hospital | Not reported | Not reported | 2/10 | Not reported |
| Death in the ICU | |||||||||||
| Mortality at 28 days | |||||||||||
| Brochardet al.7 | LVT + FiO2−LPEEP vs. HVT + FiO2−LPEEP | 6 | 116 | 57.0 ± 15.3/56.5 ± 15.3 | 144/155a | ARDS | *Mortality at 60 days | 23.1 ± 20.2/21.4 ± 16.3 | 33.5 ± 28.7/29.7 ± 19.4 | Not reported | Not reported |
| Confalonieriet al.8 | LVT + FiO2−LPEEP vs. HVT + FiO2−LPEEP | 6 | 52 | 49.8/46.9a | 150 ± 69/128 ± 51 | ARDS | *Death In hospital | Not reported | Not reported | 2/1 | Not reported |
| Estebanet al.42 | LVT + FiO2−LPEEP vs. PCV + FiO2−LPEEP | 7 | 79 | 59 ± 16/56 ± 17 | 131 ± 48/126 ± 47 | ARDS | *Death In hospital | Not reported | 25 ± 19/21 ± 15 | 4/6 | 30 ± 24/27 ± 20 |
| Death in the ICU | |||||||||||
| ARDSnetwork4 | LVT + FiO2−LPEEP vs. HVT + FiO2−LPEEP | 6 | 861 | 51 ± 17/52 ± 18 | 138 ± 64/134 ± 58 | ARDS | *Death In hospital | 12 ± 11/10 ± 11 | Not reported | 43/47 | Not reported |
| Gattinoni6 | HVT + FiO2−LPEEP vs. HVT + FiO2−LPEEP + prone | 5 | 304 | 57 ± 16/59 ± 17 | 129.5 ± 47.5/125.3 ± 48.8 | ARDS | *Mortality at 10 days | Not reported | Not reported | Not reported | Not reported |
| Kacmareket al.35 | LVT + FiO2−HPEEP vs. LVT + FiO2−HPEEP + LDPLV vs. LVT + FiO2−HPEEP + HDPLV | 7 | 311 | 46 ± 12/45 ± 14/45 ± 13 | 147 ± 54/137 ± 58/143 ± 52 | ARDS | *Mortality at 28 days | 13.0 ± 9.3/7.4 ± 8.5/9.9 ± 9.1 | Not reported | 3/8/13 | Not reported |
| Longet al.36 | LVT + FiO2−HPEEP vs. PV−PEEP and VT + RM | 4 | 30 | 61 ± 16/58 ± 18 | 142 ± 34/120 ± 29 | ARDS | *Mortality at 28 days | 4(1–8)/11(5–8)b | 3(0–8)/ 11(5–16)b | 2/0 | Not reported |
| Wanget al.37 | BiPAP + RM vs. LVT + FiO2−LPEEP | 4 | 28 | 36 ± 8/38 ± 9 | 180 ± 10/179 ± 9 | ARDS | *Mortality at 28 days | 14 ± 3/19 ± 3 | Not reported | 1/1 | Not reported |
| Didieret al.71 | LVT + FiO2−LPEEP + PRONEvs. HFOV vs. LVT + FiO2−LPEEP + HFOV + prone | 4 | 43 | 52 ± 13/45 ± 14/56 ± 17 | 122 ± 28 | ARDS | *Death in the ICU | Not reported | Not reported | Not reported | Not reported |
| Xiet al.44 | LVT + FiO2−LPEEP + RM vs. LVT + FiO2−LPEEP | 6 | 110 | 62.2 ± 16.0/65.5 ± 15.2 | 93.8 (68.7–150.0)/120.0 (88.3–140.0)b | ARDS | *Death in hospital | 10.8 ± 10.1/10.8 ± 10.1 | 22.5 ± 22.2/19.8 ± 24.8 | Not reported | 43.2 ± 45.6/33.2 ± 34.0 |
| Mortality at 28 days | |||||||||||
| Death in ICU | |||||||||||
| Hodgson40 | permissive hypercapnia + RM + LAP vs. LVT + FiO2−LPEEP | 7 | 20 | 60 ± 5/58 ± 4 | 155/149a | ARDS | *Death in hospital | 180(87–298)/341(131–351)b | 9.9 (5.6–14.8)/16.0 (8.1–19.3)b | Not reported | 17.9 (13.7–34.5)/24.7 (20.5–39.8)b |
| Dolinayet al.72 | APRV vs. LVT + FiO2−LPEEP | 4 | 34 | Not reported | Not reported | ARDS | *Death in hospital | 6.4/7.7a | Not reported | Not reported | 8.6/10.3a |
| Death in ICU | |||||||||||
| Younget al.45 | HFOV vs. LVT + FiO2−LPEEP | 5 | 795 | 55.4 ± 16.2 | 113 ± 38/113 ± 37 | ARDS | Mortality at 30 days | Not reported | 17.6 ± 16.6/16.1 ± 15.2 | Not reported | 33.9 ± 41.6/33.1 ± 44.3 |
| Death in ICU | |||||||||||
| *Death in hospital | |||||||||||
| Fergusonet al.73 | HFOV vs. LVT + FiO2−HPEEP | 5 | 548 | 55 ± 16/54 ± 16 | 121 ± 46/114 ± 38 | ARDS | *Death in hospital | 11(7–19)/10(6–18)b | Not reported | 46/34 | 30(16–45)/25(15–41)b |
| Death in ICU | |||||||||||
| Mortality at 28 days | |||||||||||
| Pintadoet al.46 | LVT + PV individual PEEP vs. LVT + FiO2−LPEEP | 5 | 70 | 55.6 ± 3.1 | 133.15 ± 5.88/146.33 ± 6.19 | ARDS | *Mortality at 28 days | Not reported | 21 (15–46)/20 (12–29)b | 6/6 | 55 ± 7/32 ± 3 |
| Beinet al.47 | LVT + FiO2−HPEEP vs. LVT + FiO2−HPEEP | 5 | 79 | 49.8 ± 12/48.7 ± 17 | 152 ± 37/168 ± 37 | ARDS | *Death in hospital | Not reported | 31.3 ± 23/22.9 ± 11 | Not reported | 46.7 ± 33/35.1 ± 17 |
| Rappaportet al.64 | HVT + FiO2−LPEEP vs. PCV + FiO2−LPEEP | 6 | 27 | 51.6 ± 6.3/43.1 ± 4.3 | 77.5 ± 9.85/74.4 ± 6.54 | ARDS | *Mortality at 30 days | Not reported | Not reported | 1/0 | Not reported |
| Hirschlet al.34 | HVT + HDPLV vs. HVT + FiO2−LPEEP | 6 | 90 | 44 ± 2/41 ± 3 | 178 ± 12/198 ± 22 | ARDS | *Mortality at 28 days | 6.3 ± 1/6.7 ± 1.8 | Not reported | 15/5 | Not reported |
| Varpula et al.74 | APRV vs. PC SIMV + PV-HPEEP | 4 | 58 | 50.0 (38.5–60.5)/44.0(35.5–53.0)b | 150.0 ± 10.5/164.3 ± 10.5 | ARDS | Mortality at day 28 | 13.4 ± 1.7/12.2 ± 1.5 | 11.9 ± 1.7/10.7 ± 1.4 | Not reported | Not reported |
| *Mortality at 1 year | |||||||||||
| Roy et al.32 | LVT + FiO2−LPEEP vs. LVT + FiO2−HPEEP | 7 | 549 | 49 ± 17/54 ± 17 | 165 ± 77/151 ± 67 | ARDS | *Death in hospital | Not reported | Not reported | 27/30 | Not reported |
| CHEN et al.70 | PCV + FiO2−LPEEP vs. HVT + FiO2-LPEEP | 4 | 56 | 16–68/18–65c | < 200 | ARDS | Not reported | Not reported | Not reported | 2/8 | Not reported |
| Taccone et al.31 | LVT + FiO2−LPEEP + PRONE vs. LVT + FiO2−LPEEP | 7 | 342 | 60/61a | 141/77a | ARDS | Mortality at day 28 | 25(12–28)/19(9–28)b | 17.5(9–31)/16(8–26)b | Not reported | Not reported |
| Death in ICU | |||||||||||
| *Mortality at 6 months | |||||||||||
| Varpula et al.75 | APRV vs. PC SIMV + PV-HPEEP | 4 | 37 | Not reported | 158/65a | ARDS | *Mortality at day 7 | Not reported | Not reported | Not reported | Not reported |
| Agarwal et al.41 | LVT + FiO2−LPEEP vs. ASV | 7 | 48 | 29.7 ± 11.6/31.4 ± 14.9 | 96.6 ± 34.5/107.3 ± 41.9 | ARDS | *Death in hospital | 6 (3.5–11.5)/5(3–11)b | 9 (4.5–15.5)/8(6–14)b | Not reported | 11 (6.5–18.5)/11 (8–16) |
| Derdak30 | HFOV vs. LVT + FiO2−HPEEP | 7 | 148 | 48 ± 17/51 ± 18 | 114 ± 37/111 ± 42 | ARDS | Mortality at 30 days | 22 ± 21/20 ± 31 | Not reported | 7/9 | Not reported |
| *Mortality at 6 months | |||||||||||
| Bollen29 | HFOV vs. LVT + FiO2−HPEEP | 7 | 61 | 81.0 ± 20.5/81.7 ± 12.5 | < 200 | ARDS | *Mortality at 30 days | 20 ± 6/18 ± 5 | Not reported | 1/1 | Not reported |
| Villar et al.76 | LVT + PV-HPEEP vs. HVT + FiO2−LPEEP | 7 | 95 | 48(28–62)/52(40–69) | 124 ± 54/139 ± 43 | ARDS | Death in ICU | 10.9 ± 9.4/6.0 ± 7.9 | Not reported | 2/4 | Not reported |
| *Death in hospital | |||||||||||
| Voggenreiter et al.77 | LVT + FiO2−HPEEP + PRONE vs. LVT + FiO2−HPEEP | 5 | 40 ± 14/43 ± 10 | 215 ± 63/228 ± 75 | ARDS | *Mortality at 90 days | 30 ± 17/33 ± 23 | Not reported | Not reported | Not reported | |
| Mercat et al.10 | LVT + PV-HPEEP vs. LVT + FiO2−LPEEP | 5 | 767 | 60 ± 16/60 ± 15 | 143 ± 57/144 ± 58 | ARDS | *Death in hospital | 7(0.0–19)/3 (0.0–17)d | Not reported | 26/22 | Not reported |
| Mortality at 28 days | |||||||||||
| Mortality at 60 days | |||||||||||
| Guérin et al.5 | LVT + FiO2−LPEEP + PRONE vs. LVT + FiO2−LPEEP | 5 | 466 | 58 ± 16/60 ± 16 | 100 ± 20/100 ± 30 | ARDS | Mortality at 28 days | 17 ± 16/19 ± 21 | 24 ± 22/26 ± 27 | 15/13 | Not reported |
| *Mortality at 90 days | |||||||||||
| Fernandez et al.38 | LVT + FiO2−LPEEP + PRONE vs. LVT + FiO2−LPEEP | 5 | 40 | 53.9 ± 17.9/55.3 ± 14.6 | 157.8 ± 83.8/153.2 ± 59.4 | ARDS | *Mortality at 60 days | 11.9 ± 9.2/15.7 ± 16.9 | 14.7 ± 9.7/17.5 ± 16.1 | 0/1 | 31.3 ± 26.4/25.5 ± 17.4 |
| Huh et al.39 | LVT + ARM vs. LVT + FiO2−LPEEP | 4 | 57 | 55.0 ± 3.7/62.0 ± 2.2 | 110.8 ± 6.3/ 115.0 ± 8.5 | ARDS | *Mortality at 60 days | 19.8 ± 0.5/15.2 ± 3.2 | 25.1 ± 5.6/21.4 ± 5.3 | 3/3 | Not reported |
| Mortality at 28 days | |||||||||||
| Death in ICU | |||||||||||
| Mentzelopouloset al.78 | HFOV + RM vs. LVT + FiO2−LPEEP | 7 | 125 | 50.7 ± 17.7/52.9 ± 17.1 | 96.5 ± 31.3/106.9 ± 27.7 | ARDS | *Death in hospital | Not reported | 31.9 ± 23.4/37.4 ± 19.6 | Yes | 52.8 ± 30.6/64.2 ± 27.8 |
| Sun et al.79 | PC SIMV + FiO2−LPEEP vs. LVT + FiO2−LPEEP | 4 | 85 | 50 ± 17/51 ± 8 | ≤ 300 | ARDS | *Mortality at 28 days | 8.4 ± 2.1/10.7 ± 1.2 | 10.2 ± 2.2/13.7 ± 3.1 | Not reported | Not reported |
| Talmoret al.43 | LVT + esophageal pressure-PEEP vs. LVT + FiO2−LPEEP | 6 | 61 | 54.5 ± 16.1/51.2 ± 23.0 | 147 ± 56/145 ± 57 | ARDS | *Mortality at 180 days | 12.0(7.0–27.5)/16.0(7.0–20.0)d | 15.5(10.8–28.5)/13.0(7.0–22.0)d | 0/0 | Not reported |
| Mortality at 28 days | |||||||||||
(Regimens are described in Table 3).
*primary outcomes for overall survival.
amean.
bmedian (interquartile range).
crange.
dmean (interquartile range). Abbreviations: ARDS, Acute Respiratory Distress Syndrome; ICU, Intensive Care Unit. Reference to ARDS Clinical Trials Network (37), ARDS Network (4) and Taccone’s (31) method, based on the primary study, high PEEP was defined by PEEP < 10 cm H2O, low tidal volume was defined by VT < 8 mL/kg.