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. 2021 Mar 30;2021(3):CD009098. doi: 10.1002/14651858.CD009098.pub3

Comparison 1. High versus low levels of PEEP.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1.1 Mortality before hospital discharge 7 3640 Risk Ratio (M‐H, Fixed, 95% CI) 0.97 [0.90, 1.04]
1.2 Oxygen efficiency (PaO₂/FIO₂) Day 1 6 2594 Mean Difference (IV, Random, 95% CI) 51.03 [35.86, 66.20]
1.3 Oxygen efficiency (PaO₂/FIO₂) Day 3 6 2309 Mean Difference (IV, Random, 95% CI) 50.32 [34.92, 65.72]
1.4 Oxygen efficiency (PaO₂/FIO₂) Day 7 5 1611 Mean Difference (IV, Fixed, 95% CI) 28.52 [20.82, 36.21]
1.5 Oxygen efficiency (PaO₂/FIO₂) Day 1. Subgroup: patients with ARDS 3 409 Mean Difference (IV, Random, 95% CI) 49.47 [15.49, 83.44]
1.6 Oxygen efficiency (PaO₂/FIO₂) Day 3. Subgroup: patients with ARDS 3 401 Mean Difference (IV, Random, 95% CI) 55.96 [41.39, 70.53]
1.7 Barotrauma 9 3791 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.64, 1.57]
1.8 Barotrauma. Subgroup: patients with ARDS 4 1419 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.33, 2.96]
1.9 Ventilator‐free days (only studies reporting means) 3 1654 Mean Difference (IV, Random, 95% CI) 0.45 [‐2.02, 2.92]
1.10 Ventilator‐free days. Subgroup: patients with ARDS 2 1105 Mean Difference (IV, Random, 95% CI) 1.66 [‐4.20, 7.52]
1.11 Mortality before hospital discharge (studies comparing high vs low levels of PEEP with or without other interventions) 9 3788 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.80, 1.02]
1.12 Mortality within 28 days of randomisation 7 3187 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.73, 1.06]
1.13 Mortality before hospital discharge. Subgroup: patients with ARDS 4 1341 Risk Ratio (M‐H, Fixed, 95% CI) 1.04 [0.95, 1.15]
1.14 Mortality before hospital discharge. Subgroup: PEEP administered according to mechanical characteristics of the lung 5 2108 Risk Ratio (M‐H, Fixed, 95% CI) 1.00 [0.92, 1.09]
1.15 Mortality before hospital discharge. Subgroup: PEEP administered according to FIO₂ and PaO₂ 2 1532 Risk Ratio (M‐H, Fixed, 95% CI) 0.90 [0.79, 1.04]
1.16 Mortality before hospital discharge. Subgroup: high PEEP and low tidal volume vs low PEEP and high tidal volume 2 148 Risk Ratio (M‐H, Fixed, 95% CI) 0.62 [0.44, 0.87]
1.17 Mortality before hospital discharge. Subgroup (post‐hoc): high PEEP with previous recruitment manoeuvre 5 2324 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.87, 1.11]
1.18 Mortality before hospital discharge. Subgroup (post‐hoc): decremental PEEP with previous recruitment manoeuvre 4 1342 Risk Ratio (M‐H, Fixed, 95% CI) 1.05 [0.95, 1.15]
1.19 Mortality before hospital discharge. Sensitivity analysis: exclusion of studies at unclear and high risk of bias 2 1750 Risk Ratio (M‐H, Fixed, 95% CI) 0.90 [0.80, 1.02]
1.20 Mortality before hospital discharge. Sensitivity analysis: exclusion of studies with large effect sizes 6 2632 Risk Ratio (M‐H, Fixed, 95% CI) 0.90 [0.81, 1.00]
1.21 Ventilator‐free days 7   Other data No numeric data
1.22 Length of stay in ICU 6   Other data No numeric data