当前位置： SCI文献检索 > CRITICAL CARE MEDICINE期刊下所有文献 > Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Abstract：

OBJECTIVES:A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality for higher versus lower driving pressure. DATA SOURCES:MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane CENTRAL from inception to February 10, 2017. STUDY SELECTION:Studies including mechanically ventilated adult patients with acute respiratory distress syndrome, reporting driving pressure and mortality. DATA EXTRACTION:Seven studies including five secondary analysis of previous randomized controlled trials and two observational studies (6,062 patients) were eligible for study. All studies were judged as having a low risk of bias. Median (interquartile range) driving pressure between higher and lower driving pressure groups was 15 cm H2O (14-16 cm H2O). Median (interquartile range) mortality of all included studies was 34% (32-38%). DATA SYNTHESIS:In the meta-analyses of four studies (3,252 patients), higher driving pressure was associated with a significantly higher mortality (pooled risk ratio, 1.44; 95% [CI], 1.11-1.88; I = 85%). A sensitivity analysis restricted to the three studies with similar driving pressure cutoffs (13-15 cm H2O) demonstrated similar results (pooled risk ratio, 1.28; 95% CI, 1.14-1.43; I = 0%). CONCLUSIONS:Our study confirmed an association between higher driving pressure and higher mortality in mechanically ventilated patients with acute respiratory distress syndrome. These findings suggest a possible range of driving pressure to be evaluated in clinical trials. Future research is needed to ascertain the benefit of ventilatory strategies targeting driving pressure in patients with acute respiratory distress syndrome.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Aoyama H,Pettenuzzo T,Aoyama K,Pinto R,Englesakis M,Fan E

doi

10.1097/CCM.0000000000002838

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

300-306

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

杂志文章,meta分析

在线工具

Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.