Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis
Objectives. Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association betwe...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2019/4654705 |
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| author | Zhen Chen Xuxia Wei Genglong Liu Qiang Tai Donghua Zheng Wenfeng Xie Li Chen Ganping Wang Jia-Qi Sun Siqi Wang Na Liu Haijin Lv Liuer Zuo |
| author_facet | Zhen Chen Xuxia Wei Genglong Liu Qiang Tai Donghua Zheng Wenfeng Xie Li Chen Ganping Wang Jia-Qi Sun Siqi Wang Na Liu Haijin Lv Liuer Zuo |
| author_sort | Zhen Chen |
| collection | DOAJ |
| description | Objectives. Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association between DP and mortality among ventilated patients with ARDS. Methods. PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase were systematically searched from inception to June 2018. Two investigators conducted the literature search study selection, data extraction, and quality evaluation independently. RevMan 5.3 software was used for all statistical analyses. Results. A total of seven studies comprising 8010 patients were included in this meta-analysis. Higher DP showed a significant association with higher mortality (pooled risk ratio, 1.10; 95% [CI], 1.05–1.16; I2 =58%). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. One of the subgroups investigated, ARDS severity, could account for the heterogeneity. An exploratory post hoc subgroup analysis and higher DP significantly increased mortality in the mild to severe ARDS subgroup (RR 1.28; 95% [CI], 1.14–1.43; I2 =0), but not in the moderate to severe ARDS subgroup (RR 1.18; 95% [CI], 0.95–1.46; I2 =52%). Conclusion. Higher DP was significantly associated with an increased risk of death among ventilated patients with ARDS. But it did not seem to predict prognosis to moderate to severe ARDS. Future prospective randomized clinical trials are needed to verify the results of this meta-analysis and address the unresolved questions about optimum cutoff values for DP. Trial Registration. This trial is registered with PROSPERO (CRD42018102146), on 11 August 2018. |
| format | Article |
| id | doaj-art-b4749cd90d39405e92d3f9136af703a5 |
| institution | OA Journals |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-b4749cd90d39405e92d3f9136af703a52025-08-20T02:23:12ZengWileyEmergency Medicine International2090-28402090-28592019-01-01201910.1155/2019/46547054654705Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-AnalysisZhen Chen0Xuxia Wei1Genglong Liu2Qiang Tai3Donghua Zheng4Wenfeng Xie5Li Chen6Ganping Wang7Jia-Qi Sun8Siqi Wang9Na Liu10Haijin Lv11Liuer Zuo12Intensive Care Unit, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan 528308, Guangdong Province, ChinaSurgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, ChinaDepartment of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaIntensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, ChinaSurgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, ChinaIntensive Care Unit, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan 528308, Guangdong Province, ChinaObjectives. Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association between DP and mortality among ventilated patients with ARDS. Methods. PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase were systematically searched from inception to June 2018. Two investigators conducted the literature search study selection, data extraction, and quality evaluation independently. RevMan 5.3 software was used for all statistical analyses. Results. A total of seven studies comprising 8010 patients were included in this meta-analysis. Higher DP showed a significant association with higher mortality (pooled risk ratio, 1.10; 95% [CI], 1.05–1.16; I2 =58%). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. One of the subgroups investigated, ARDS severity, could account for the heterogeneity. An exploratory post hoc subgroup analysis and higher DP significantly increased mortality in the mild to severe ARDS subgroup (RR 1.28; 95% [CI], 1.14–1.43; I2 =0), but not in the moderate to severe ARDS subgroup (RR 1.18; 95% [CI], 0.95–1.46; I2 =52%). Conclusion. Higher DP was significantly associated with an increased risk of death among ventilated patients with ARDS. But it did not seem to predict prognosis to moderate to severe ARDS. Future prospective randomized clinical trials are needed to verify the results of this meta-analysis and address the unresolved questions about optimum cutoff values for DP. Trial Registration. This trial is registered with PROSPERO (CRD42018102146), on 11 August 2018.http://dx.doi.org/10.1155/2019/4654705 |
| spellingShingle | Zhen Chen Xuxia Wei Genglong Liu Qiang Tai Donghua Zheng Wenfeng Xie Li Chen Ganping Wang Jia-Qi Sun Siqi Wang Na Liu Haijin Lv Liuer Zuo Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis Emergency Medicine International |
| title | Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis |
| title_full | Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis |
| title_fullStr | Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis |
| title_short | Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis |
| title_sort | higher vs lower dp for ventilated patients with acute respiratory distress syndrome a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2019/4654705 |
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