Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis
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.
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.
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.
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.
KeywordsIntensive care unit Critical care Acute respiratory distress syndrome ARDS Lung recruitment
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.
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.
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