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Table 1 Study description

From: Effects of higher PEEP and recruitment manoeuvres on mortality in patients with ARDS: a systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials

     Treatments
     Intervention group Control group
Study PaO2/FIO2 (mmHg) Patients (centres) Mortality time points Aim Ventilation strategy Recruitment manoeuvres Aim Ventilation strategy
Studies investigating higher PEEP with TV reduction
Amato 1998* < 200 53 (2) 28 days
In hospital
In ICU
Maintaining lung recruitment with higher PEEP, lower TV plus RMs TV < 6 mL/kg
PEEP = PFLEX + 2 cmH2O
PDRIV < 20 cmH2O
PPEAK < 40 cmH2O
CPAP of 35–40 cmH2O for 40s Maintaining oxygenation, using low PEEP and high TV TV = 12 mL/kg
PEEP ≥ 5 cmH2O
Stepwise PEEP titration table targeting PaO2 ≥ 80 mmHg
Villar 2006* < 200 95 (8) In-hospital
In ICU
Maintaining oxygenation while increasing lung recruitment, with higher PEEP and lower TV TV 5–8 mL/kg
PEEP = PFLEX + 2 cmH2O
No Maintaining oxygenation using low PEEP and high TV TV 9–11 mL/kg
PEEP ≥ 5 cmH2O
Studies investigating higher PEEP without recruitment manoeuvres
Brower 2004 < 300 549 (23) In-hospital Maintaining oxygenation prioritizing PEEP over FIO2 (higher PEEP levels) TV 6 mL/kg
Higher PEEP/FIO2 table
Only in first 80 patients Maintaining oxygenation prioritizing FIO2 over PEEP (lower PEEP levels) TV 6 mL/kg
Lower PEEP/FIO2 table
PPLAT < 30 cmH2O
Mercat 2008 < 300 767 (37) 28 days in-hospital Increasing alveolar recruitment while limiting hyperinflation with higher PEEP TV 6 mL/kg
Highest PEEP resulting in PPLAT < 28––30 cmH2O
Not recommended Minimizing alveolar distension with a moderate-low PEEP strategy TV 6 mL/kg
PEEP 5–9 cmH2O
Talmor 2008 < 300 61 (1) 28 days Maintaining oxygenation setting PEEP based on transpulmonary pressure TV 6 mL/kg
PEEP set to achieve:
End-expiratory transpulmonary pressure 0–10 cmH2O
End-inspiratory transpulmonary pressure < 25 cmH2O
No Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
PPLAT < 30 cmH2O
Studies investigating higher PEEP with recruitment manoeuvres
Meade 2008 < 250 983 (30) 28 days
In-hospital
In ICU
Maintaining an ‘open-lung approach’ based on oxygenation goals TV 6 mL/kg
Higher PEEP/FIO2 table
PPLAT < 40 cmH2O
CPAP 40 cmH2O for 40 s Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
PPLAT < 30 cmH2O
Huh 2009 < 200 57 (1) 28 days
60 days
In ICU
Individualisation of PEEP according to compliance and oxygenation TV 6 mL/kg
PEEP set with a decremental trial at the lowest value without decrease in saturation or compliance
PEEP increased from baseline to 25 cmH2O Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
Hodgson 2011 < 200 20 (1) In-hospital Lung recruitment and individualisation of PEEP according to oxygenation TV < 6 mL/kg
Decremental PEEP until desaturation ≥1%
PEEP increased to 40 cmH2O and reduced to 15 cmH2O Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
Kacmarek 2016 < 200 200 (20) 28 days
60 days
In-hospital
In ICU
Maintaining an ‘open-lung approach’ TV 6 mL/kg
Decremental PEEP to the best dynamic compliance
PPEAK 50-60
cmH2O
PEEP 35–45 cmH2O
Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
Cavalcanti 2017 < 200 1004 (120) 28 days
In-hospital
In ICU
Maintaining an ‘open-lung approach’ TV 6 mL/kg
PEEP ≥ 11 cmH2O, set to the lowest PDRIV in a decremental titration
PPLAT ≤ 50 cmH2O
PEEP increased to 35 cmH2O
Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
Hodgson 2019 < 200   28 days
60 days
In-hospital
In ICU
6 months
Lung recruitment and individualisation of PEEP according to oxygenation TV < 6 mL/kg
Decremental PEEP until desaturation ≥ 2%
PEEP increased to 40 cmH2O and reduced to 15 cmH2O Maintaining oxygenation TV 6 mL/kg
Lower PEEP/FIO2 table
Studies investigating recruitment manoeuvres alone
Xi 2010 200 110 (14) 28 days
In-hospital
In ICU
Maintaining lung recruitment with RMs only TV 6–8 mL/kg
Lower PEEP/FIO2 table
RM performed by CPAP
CPAP of 40 cmH2O for 40s Maintaining oxygenation TV 6-8 mL/kg
Lower PEEP/FIO2 table
PPLAT < 30 cmH2O
  1. *Excluded from the meta-analysis as the intervention group received a lower tidal volume compared to the control group
  2. PEEP positive end-expiratory pressure, TV tidal volume, CPAP continuous positive airway pressure, PFLEX lower inflection point, PDRIV driving pressure, PPEAK:peak pressure, RM, recruitment manoeuvre.