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Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis

  • Joris Pensier
  • Audrey de Jong
  • Zied Hajjej
  • Nicolas Molinari
  • Julie Carr
  • Fouad Belafia
  • Gérald Chanques
  • Emmanuel Futier
  • Elie Azoulay
  • Samir JaberEmail author
Seven-Day Profile Publication

Abstract

Purpose

Among acute respiratory distress syndrome (ARDS) patients in intensive care units, the efficacy of lung recruitment maneuver (LRM) use is uncertain taking into account the most recent randomized controlled trials (RCTs). We aimed to estimate the effect of LRMs on mortality from ARDS.

Methods

In this systematic review and meta-analysis, we searched for RCTs comparing mechanical ventilation with and without LRMs in adults with ARDS. We generated pooled relative risks (RR), mean difference, performed trial-sequential-analysis and cumulative meta-analysis. The primary outcome was 28-day mortality. The secondary outcomes were oxygenation evaluated by PaO2/FiO2 ratio, rate of rescue therapy and rate of hemodynamic compromise.

Results

In 14 RCTs including 3185 patients, LRMs were not associated with reduced 28-day mortality (RR = 0.92, 95% confidence interval (95% CI) 0.82–1.04, P = 0.21), compared to no-LRM. Trial-sequential-analysis showed that the required information size has been accrued. PaO2/FiO2 ratio was significantly higher in the LRMs group in comparison to the no-LRM group (mean difference = 47.6 mmHg, 95% CI 33.4–61.8, P < 0.001). LRMs were associated with a decreased rate of rescue therapy (RR = 0.69 95% CI 0.56–0.84, P < 0.001), and an increased rate of hemodynamic compromise (RR = 1.19, 95% CI 1.06–1.33, P = 0.002), compared to no-LRM group. Using cumulative meta-analysis, a significant change for effect on mortality was observed after 2017.

Conclusions

The results suggest that in ARDS patients, systematic use of LRMs does not significantly improve 28-day mortality. However, LRM use was associated with positive effects such as an oxygenation improvement and a less frequent use of rescue therapy. Nevertheless, LRM use was associated with negative effects such as hemodynamic impairment.

Keywords

Intensive care unit Critical care Acute respiratory distress syndrome ARDS Lung recruitment 

Notes

Author contributions

SJ contributed to the conception and design of the study; to the analysis and interpretation of data; to drafting the submitted article, and to provide final approval of the version to be published. JP contributed to conception and design of the study, to the acquisition of the data, to the analysis of the data, to drafting the submitted article, and to provide final approval of the version to be published. ADJ contributed to conception and design of the study, to the acquisition of the data, to the analysis of the data, to drafting the submitted article, and to provide final approval of the version to be published. GC contributed to the conception and the design of the study, to the acquisition of the data, to drafting the submitted article and to provide final approval of the version to be published. NM contributed to the analysis and interpretation of data, to drafting the submitted article, and to provide final approval of the version to be published. All authors provide agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

The study is an investigator-initiated trial. No funder had a role in the design or conduct of the study, data collection, analysis or interpretation, the writing of the report or in the decision to submit for publication. The corresponding author had full access to all of the data and the final responsibility to submit for publication.

Compliance with ethical standards

Conflicts of interest

Pr. Jaber reports receiving consulting fees from Drager, Medtronic, Baxter and Fisher & Paykel. No potential conflict of interest relevant to this article was reported for the other authors.

Supplementary material

134_2019_5821_MOESM1_ESM.docx (1.6 mb)
Supplementary material 1 (DOCX 1587 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching HospitalCentre Hospitalier Universitaire MontpellierMontpellier cedex 5France
  2. 2.Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, Centre Hospitalier Universitaire MontpellierUniversity of Montpellier, INSERM U1046, CNRS UMR 9214Montpellier cedex 5France
  3. 3.Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Military Hospital of TunisUniversity of Tunis El ManarTunisTunisia
  4. 4.Department of StatisticsUniversity of Montpellier Lapeyronie Hospital, UMR 729 MISTEAMontpellierFrance
  5. 5.Département de Médecine Périopératoire, Anesthésie et RéanimationCentre Hospitalier Universitaire Clermont-FerrandClermont-FerrandFrance
  6. 6.Medical Intensive Care Unit, APHPHôpital St-LouisParisFrance

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