Intensive Care Medicine

, Volume 40, Issue 6, pp 769–787 | Cite as

Effects of interventions on survival in acute respiratory distress syndrome: an umbrella review of 159 published randomized trials and 29 meta-analyses

  • Adriano R. Tonelli
  • Joe Zein
  • Jacob Adams
  • John P. A. Ioannidis
Systematic Review

Abstract

Purpose

Multiple interventions have been tested in acute respiratory distress syndrome (ARDS). We examined the entire agenda of published randomized controlled trials (RCTs) in ARDS that reported on mortality and of respective meta-analyses.

Methods

We searched PubMed, the Cochrane Library, and Web of Knowledge until July 2013. We included RCTs in ARDS published in English. We excluded trials of newborns and children; and those on short-term interventions, ARDS prevention, or post-traumatic lung injury. We also reviewed all meta-analyses of RCTs in this field that addressed mortality. Treatment modalities were grouped in five categories: mechanical ventilation strategies and respiratory care, enteral or parenteral therapies, inhaled/intratracheal medications, nutritional support, and hemodynamic monitoring.

Results

We identified 159 published RCTs of which 93 had overall mortality reported (n = 20,671 patients)—44 trials (14,426 patients) reported mortality as a primary outcome. A statistically significant survival benefit was observed in eight trials (seven interventions) and two trials reported an adverse effect on survival. Among RCTs with more than 50 deaths in at least one treatment arm (n = 21), two showed a statistically significant mortality benefit of the intervention (lower tidal volumes and prone positioning), one showed a statistically significant mortality benefit only in adjusted analyses (cisatracurium), and one (high-frequency oscillatory ventilation) showed a significant detrimental effect. Across 29 meta-analyses, the most consistent evidence was seen for low tidal volumes and prone positioning in severe ARDS.

Conclusions

There is limited supportive evidence that specific interventions can decrease mortality in ARDS. While low tidal volumes and prone positioning in severe ARDS seem effective, most sporadic findings of interventions suggesting reduced mortality are not corroborated consistently in large-scale evidence including meta-analyses.

Keywords

Acute respiratory distress syndrome Treatment Survival Mortality 

Abbreviations

APACHE

Acute Physiology and Chronic Health Evaluation

APVR

Airway pressure release ventilation

ARDS

Acute respiratory distress syndrome

ARM

Alveolar recruitment maneuvers

CI

Confidence interval

HFOV

High-frequency oscillatory ventilation

HR

Hazard ratio

ICU

Intensive care unit

IV

Intravenous

M

Mortality

MV

Mechanical ventilation

NA

Not available

OR

Odds ratio

PAC

Pulmonary artery catheter

PCV

Pressure-controlled ventilation

PEEP

Positive end-expiratory pressure

PGE1

Prostaglandin E1

PLV

Partial liquid ventilation

PO

By mouth

PPV

Positive pressure ventilation

RCT

Randomized controlled trial

RR

Relative risk

SIMV

Synchronized intermittent ventilation

SOFA

Sequential Organ Failure Assessment score

VCV

Volume-controlled ventilation

Supplementary material

134_2014_3272_MOESM1_ESM.doc (879 kb)
Supplementary material 1 (DOC 879 kb)

References

  1. 1.
    Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38:1573–1582PubMedCrossRefGoogle Scholar
  2. 2.
    Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, Gandia F, Carriedo D, Mosteiro F, Basaldua S, Fernandez RL, Kacmarek RM (2011) The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med 37:1932–1941PubMedCrossRefGoogle Scholar
  3. 3.
    Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R, Pesenti A, Guerin C, Mancebo J, Curley MA, Fernandez R, Chan MC, Beuret P, Voggenreiter G, Sud M, Tognoni G, Gattinoni L (2010) Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med 36:585–599PubMedCrossRefGoogle Scholar
  4. 4.
    Bersten AD, Edibam C, Hunt T, Moran J (2002) Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med 165:443–448PubMedCrossRefGoogle Scholar
  5. 5.
    Montgomery AB, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 132:485–489PubMedGoogle Scholar
  6. 6.
    Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V, Raymondos K, Rios F, Nin N, Apezteguia C, Violi DA, Thille AW, Brochard L, Gonzalez M, Villagomez AJ, Hurtado J, Davies AR, Du B, Maggiore SM, Pelosi P, Soto L, Tomicic V, D’Empaire G, Matamis D, Abroug F, Moreno RP, Soares MA, Arabi Y, Sandi F, Jibaja M, Amin P, Koh Y, Kuiper MA, Bulow HH, Zeggwagh AA, Anzueto A (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 188:220–230PubMedCrossRefGoogle Scholar
  7. 7.
    Girard TD, Bernard GR (2007) Mechanical ventilation in ARDS: a state-of-the-art review. Chest 131:921–929PubMedCrossRefGoogle Scholar
  8. 8.
    Ioannidis JP (2005) Why most published research findings are false. PLoS Med 2:e124PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Bassler D, Briel M, Montori VM, Lane M, Glasziou P, Zhou Q, Heels-Ansdell D, Walter SD, Guyatt GH, Flynn DN, Elamin MB, Murad MH, Abu Elnour NO, Lampropulos JF, Sood A, Mullan RJ, Erwin PJ, Bankhead CR, Perera R, Ruiz Culebro C, You JJ, Mulla SM, Kaur J, Nerenberg KA, Schunemann H, Cook DJ, Lutz K, Ribic CM, Vale N, Malaga G, Akl EA, Ferreira-Gonzalez I, Alonso-Coello P, Urrutia G, Kunz R, Bucher HC, Nordmann AJ, Raatz H, da Silva SA, Tuche F, Strahm B, Djulbegovic B, Adhikari NK, Mills EJ, Gwadry-Sridhar F, Kirpalani H, Soares HP, Karanicolas PJ, Burns KE, Vandvik PO, Coto-Yglesias F, Chrispim PP, Ramsay T (2010) Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA 303:1180–1187PubMedCrossRefGoogle Scholar
  10. 10.
    Ioannidis JP, Karassa FB (2010) The need to consider the wider agenda in systematic reviews and meta-analyses: breadth, timing, and depth of the evidence. BMJ 341:c4875PubMedCrossRefGoogle Scholar
  11. 11.
    Ioannidis JP (2009) Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses. CMAJ 181:488–493PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedCrossRefGoogle Scholar
  13. 13.
    The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308Google Scholar
  14. 14.
    Abraham E, Baughman R, Fletcher E, Heard S, Lamberti J, Levy H, Nelson L, Rumbak M, Steingrub J, Taylor J, Park YC, Hynds JM, Freitag J (1999) Liposomal prostaglandin E1 (TLC C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multicenter clinical trial. TLC C-53 ARDS Study Group. Crit Care Med 27:1478–1485PubMedCrossRefGoogle Scholar
  15. 15.
    Anzueto A, Baughman RP, Guntupalli KK, Weg JG, Wiedemann HP, Raventos AA, Lemaire F, Long W, Zaccardelli DS, Pattishall EN (1996) Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med 334:1417–1421PubMedCrossRefGoogle Scholar
  16. 16.
    Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351:327–336PubMedCrossRefGoogle Scholar
  17. 17.
    Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO (2013) High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 368:795–805PubMedCrossRefGoogle Scholar
  18. 18.
    Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573PubMedCrossRefGoogle Scholar
  19. 19.
    Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M (2004) Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 292:2379–2387PubMedCrossRefGoogle Scholar
  20. 20.
    Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168PubMedCrossRefGoogle Scholar
  21. 21.
    Kesecioglu J, Beale R, Stewart TE, Findlay GP, Rouby JJ, Holzapfel L, Bruins P, Steenken EJ, Jeppesen OK, Lachmann B (2009) Exogenous natural surfactant for treatment of acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 180:989–994PubMedCrossRefGoogle Scholar
  22. 22.
    Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:637–645PubMedCrossRefGoogle Scholar
  23. 23.
    Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:646–655PubMedCrossRefGoogle Scholar
  24. 24.
    Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116PubMedCrossRefGoogle Scholar
  25. 25.
    Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 307:795–803PubMedCrossRefGoogle Scholar
  26. 26.
    Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL (2003) Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 290:2713–2720PubMedCrossRefGoogle Scholar
  27. 27.
    Spragg RG, Lewis JF, Walmrath HD, Johannigman J, Bellingan G, Laterre PF, Witte MC, Richards GA, Rippin G, Rathgeb F, Hafner D, Taut FJ, Seeger W (2004) Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N Engl J Med 351:884–892PubMedCrossRefGoogle Scholar
  28. 28.
    Spragg RG, Taut FJ, Lewis JF, Schenk P, Ruppert C, Dean N, Krell K, Karabinis A, Gunther A (2011) Recombinant surfactant protein C-based surfactant for patients with severe direct lung injury. Am J Respir Crit Care Med 183:1055–1061PubMedCrossRefGoogle Scholar
  29. 29.
    Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, Caspani L, Raimondi F, Bordone G, Iapichino G, Mancebo J, Guerin C, Ayzac L, Blanch L, Fumagalli R, Tognoni G, Gattinoni L (2009) Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA 302:1977–1984PubMedCrossRefGoogle Scholar
  30. 30.
    Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 354:2213–2224PubMedCrossRefGoogle Scholar
  31. 31.
    Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575PubMedCrossRefGoogle Scholar
  32. 32.
    Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH (2013) High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 368:806–813PubMedCrossRefGoogle Scholar
  33. 33.
    Zeiher BG, Artigas A, Vincent JL, Dmitrienko A, Jackson K, Thompson BT, Bernard G (2004) Neutrophil elastase inhibition in acute lung injury: results of the STRIVE study. Crit Care Med 32:1695–1702PubMedCrossRefGoogle Scholar
  34. 34.
    Mancebo J, Fernandez R, Blanch L, Rialp G, Gordo F, Ferrer M, Rodriguez F, Garro P, Ricart P, Vallverdu I, Gich I, Castano J, Saura P, Dominguez G, Bonet A, Albert RK (2006) A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med 173:1233–1239PubMedCrossRefGoogle Scholar
  35. 35.
    Villar J, Kacmarek RM, Perez-Mendez L, Aguirre-Jaime A (2006) A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 34:1311–1318PubMedCrossRefGoogle Scholar
  36. 36.
    Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMedCrossRefGoogle Scholar
  37. 37.
    Esteban A, Alia I, Gordo F, de Pablo R, Suarez J, Gonzalez G, Blanco J (2000) Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group. Chest 117:1690–1696PubMedCrossRefGoogle Scholar
  38. 38.
    Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, Tolley EA (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 280:159–165PubMedCrossRefGoogle Scholar
  39. 39.
    Singer P, Theilla M, Fisher H, Gibstein L, Grozovski E, Cohen J (2006) Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med 34:1033–1038PubMedCrossRefGoogle Scholar
  40. 40.
    Abroug F, Ouanes-Besbes L, Dachraoui F, Ouanes I, Brochard L (2011) An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury. Crit Care 15:R6PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Adhikari NK, Burns KE, Friedrich JO, Granton JT, Cook DJ, Meade MO (2007) Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ 334:779PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Afshari A, Brok J, Moller AM, Wetterslev J (2011) Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis. Anesth Analg 112:1411–1421PubMedCrossRefGoogle Scholar
  43. 43.
    Agarwal R, Nath A, Aggarwal AN, Gupta D (2007) Do glucocorticoids decrease mortality in acute respiratory distress syndrome? A meta-analysis. Respirology 12:585–590PubMedCrossRefGoogle Scholar
  44. 44.
    Agarwal R, Reddy C, Aggarwal AN, Gupta D (2006) Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med 100:2235–2238PubMedCrossRefGoogle Scholar
  45. 45.
    Alsaghir AH, Martin CM (2008) Effect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis. Crit Care Med 36:603–609PubMedCrossRefGoogle Scholar
  46. 46.
    Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 303:865–873PubMedCrossRefGoogle Scholar
  47. 47.
    Burns KE, Adhikari NK, Slutsky AS, Guyatt GH, Villar J, Zhang H, Zhou Q, Cook DJ, Stewart TE, Meade MO (2011) Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis. PLoS ONE 6:e14623PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Dasenbrook EC, Needham DM, Brower RG, Fan E (2011) Higher PEEP in patients with acute lung injury: a systematic review and meta-analysis. Respir Care 56:568–575PubMedCrossRefGoogle Scholar
  49. 49.
    Davidson WJ, Dorscheid D, Spragg R, Schulzer M, Mak E, Ayas NT (2006) Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis. Crit Care 10:R41PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 166:1510–1514PubMedCrossRefGoogle Scholar
  51. 51.
    Iwata K, Doi A, Ohji G, Oka H, Oba Y, Takimoto K, Igarashi W, Gremillion DH, Shimada T (2010) Effect of neutrophil elastase inhibitor (sivelestat sodium) in the treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS): a systematic review and meta-analysis. Intern Med 49:2423–2432PubMedCrossRefGoogle Scholar
  52. 52.
    Kopterides P, Siempos II, Armaganidis A (2009) Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care 24:89–100PubMedCrossRefGoogle Scholar
  53. 53.
    Lamontagne F, Briel M, Guyatt GH, Cook DJ, Bhatnagar N, Meade M (2010) Corticosteroid therapy for acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials. J Crit Care 25:420–435PubMedCrossRefGoogle Scholar
  54. 54.
    Meng H, Sun Y, Lu J, Fu S, Meng Z, Scott M, Li Q (2012) Exogenous surfactant may improve oxygenation but not mortality in adult patients with acute lung injury/acute respiratory distress syndrome: a meta-analysis of 9 clinical trials. J Cardiothorac Vasc Anesth 26:849–856PubMedCrossRefGoogle Scholar
  55. 55.
    Oba Y, Thameem DM, Zaza T (2009) High levels of PEEP may improve survival in acute respiratory distress syndrome: a meta-analysis. Respir Med 103:1174–1181PubMedCrossRefGoogle Scholar
  56. 56.
    Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A (2008) Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ 336:1006–1009PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Phoenix SI, Paravastu S, Columb M, Vincent JL, Nirmalan M (2009) Does a higher positive end expiratory pressure decrease mortality in acute respiratory distress syndrome? A systematic review and meta-analysis. Anesthesiology 110:1098–1105PubMedCrossRefGoogle Scholar
  58. 58.
    Pontes-Arruda A, Demichele S, Seth A, Singer P (2008) The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr 32:596–605PubMedCrossRefGoogle Scholar
  59. 59.
    Putensen C, Theuerkauf N, Zinserling J, Wrigge H, Pelosi P (2009) Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med 151:566–576PubMedCrossRefGoogle Scholar
  60. 60.
    Santa Cruz R, Rojas JI, Nervi R, Heredia R, Ciapponi A (2013) High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 6:CD009098PubMedGoogle Scholar
  61. 61.
    Sud S, Sud M, Friedrich JO, Meade MO, Ferguson ND, Wunsch H, Adhikari NK (2010) High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 340:c2327PubMedCrossRefGoogle Scholar
  62. 62.
    Tang BM, Craig JC, Eslick GD, Seppelt I, McLean AS (2009) Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med 37:1594–1603PubMedCrossRefGoogle Scholar
  63. 63.
    Tiruvoipati R, Bangash M, Manktelow B, Peek GJ (2008) Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis. J Crit Care 23:101–110PubMedCrossRefGoogle Scholar
  64. 64.
    Alhazzani W, Alshahrani M, Jaeschke R, Forel JM, Papazian L, Sevransky J, Meade MO (2013) Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care 17:R43PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Zhang LN, Sun JP, Xue XY, Wang JX (2013) Exogenous pulmonary surfactant for acute respiratory distress syndrome in adults: a systematic review and meta-analysis. Exp Ther Med 5:237–242PubMedCentralPubMedGoogle Scholar
  66. 66.
    Singh B, Tiwari AK, Singh K, Mommer SK, Ahmed A, Erwin PJ, Franco PM (2014) Beta-2-agonist for the treatment of acute lung injury: a systematic review and meta-analysis. Respir Care 59:288–296Google Scholar
  67. 67.
    Dee BM, Bruno JJ, Lal LS, Canada TW (2011) Effects of immune-enhancing enteral nutrition on mortality and oxygenation in acute lung injury and acute respiratory distress syndrome: a meta-analysis. Hosp Pharm 46:33–40CrossRefGoogle Scholar
  68. 68.
    Lee JM, Bae W, Lee YJ, Cho YJ (2013) The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med. doi:10.1097/CCM.0000000000000122
  69. 69.
    Contopoulos-Ioannidis DG, Ioannidis JP (2012) Claims for improved survival from systemic corticosteroids in diverse conditions: an umbrella review. Eur J Clin Invest 42:233–244PubMedCrossRefGoogle Scholar
  70. 70.
    Dwan K, Gamble C, Williamson PR, Kirkham JJ (2013) Systematic review of the empirical evidence of study publication bias and outcome reporting bias—an updated review. PLoS ONE 8:e66844PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, Carlin B, Lowson S, Granton J (2002) High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 166:801–808PubMedCrossRefGoogle Scholar
  72. 72.
    Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umberger R (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131:954–963PubMedCrossRefGoogle Scholar
  73. 73.
    Carney D, DiRocco J, Nieman G (2005) Dynamic alveolar mechanics and ventilator-induced lung injury. Crit Care Med 33:S122–S128PubMedCrossRefGoogle Scholar
  74. 74.
    Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ (2012) Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 308:1651–1659PubMedCrossRefGoogle Scholar
  75. 75.
    Beitler JR, Shaefi S, Montesi SB, Devlin A, Loring SH, Talmor D, Malhotra A (2014) Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive Care Med 40:332–341Google Scholar
  76. 76.
    Gainnier M, Roch A, Forel JM, Thirion X, Arnal JM, Donati S, Papazian L (2004) Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome. Crit Care Med 32:113–119PubMedCrossRefGoogle Scholar
  77. 77.
    Forel JM, Roch A, Marin V, Michelet P, Demory D, Blache JL, Perrin G, Gainnier M, Bongrand P, Papazian L (2006) Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome. Crit Care Med 34:2749–2757PubMedCrossRefGoogle Scholar
  78. 78.
    Saquib N, Saquib J, Ioannidis JP (2013) Practices and impact of primary outcome adjustment in randomized controlled trials: meta-epidemiologic study. BMJ 347:f4313PubMedCentralPubMedCrossRefGoogle Scholar
  79. 79.
    Altemeier WA, Sinclair SE (2007) Hyperoxia in the intensive care unit: why more is not always better. Curr Opin Crit Care 13:73–78PubMedCrossRefGoogle Scholar
  80. 80.
    Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149:1327–1334PubMedCrossRefGoogle Scholar
  81. 81.
    Siontis KC, Hernandez-Boussard T, Ioannidis JP (2013) Overlapping meta-analyses on the same topic: survey of published studies. BMJ 347:f4501PubMedCentralPubMedCrossRefGoogle Scholar
  82. 82.
    Ioannidis JP, Lau J (1997) The impact of high-risk patients on the results of clinical trials. J Clin Epidemiol 50:1089–1098PubMedCrossRefGoogle Scholar
  83. 83.
    Pereira TV, Horwitz RI, Ioannidis JP (2012) Empirical evaluation of very large treatment effects of medical interventions. JAMA 308:1676–1684PubMedCrossRefGoogle Scholar
  84. 84.
    Ioannidis JP (2008) Why most discovered true associations are inflated. Epidemiology 19:640–648PubMedCrossRefGoogle Scholar
  85. 85.
    Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP (2005) Causes and timing of death in patients with ARDS. Chest 128:525–532PubMedCrossRefGoogle Scholar
  86. 86.
    Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533PubMedGoogle Scholar
  87. 87.
    Villar J, Perez-Mendez L, Blanco J, Anon JM, Blanch L, Belda J, Santos-Bouza A, Fernandez RL, Kacmarek RM (2013) A universal definition of ARDS: the PaO2/FiO2 ratio under a standard ventilatory setting—a prospective, multicenter validation study. Intensive Care Med 39:583–592PubMedCrossRefGoogle Scholar
  88. 88.
    Mills EJ, Thorlund K, Ioannidis JP (2012) Calculating additive treatment effects from multiple randomized trials provides useful estimates of combination therapies. J Clin Epidemiol 65:1282–1288PubMedCrossRefGoogle Scholar
  89. 89.
    Doshi P, Goodman SN, Ioannidis JP (2013) Raw data from clinical trials: within reach? Trends Pharmacol Sci 34:645–647PubMedCrossRefGoogle Scholar
  90. 90.
    Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, Novack V, Loring SH (2008) Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 359:2095–2104PubMedCentralPubMedCrossRefGoogle Scholar
  91. 91.
    Huh JW, Jung H, Choi HS, Hong SB, Lim CM, Koh Y (2009) Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome. Crit Care 13:R22PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.
    Varpula T, Valta P, Niemi R, Takkunen O, Hynynen M, Pettila VV (2004) Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome. Acta Anaesthesiol Scand 48:722–731PubMedCrossRefGoogle Scholar
  93. 93.
    Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M (2006) Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 354:1671–1684PubMedCrossRefGoogle Scholar
  94. 94.
    Bone RC, Slotman G, Maunder R, Silverman H, Hyers TM, Kerstein MD, Ursprung JJ (1989) Randomized double-blind, multicenter study of prostaglandin E1 in patients with the adult respiratory distress syndrome. Prostaglandin E1 Study Group. Chest 96:114–119PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Adriano R. Tonelli
    • 1
  • Joe Zein
    • 1
  • Jacob Adams
    • 1
  • John P. A. Ioannidis
    • 2
  1. 1.Department of Pulmonary, Allergy, and Critical Care MedicineRespiratory InstituteClevelandUSA
  2. 2.Department of Medicine and Meta-Research InnovationResearch Center at Stanford (METRICS), Stanford UniversityStanfordUSA

Personalised recommendations