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Effect of mechanical ventilation guided by transpulmonary pressure in acute respiratory distress syndrome patients: a systematic review and meta-analysis of randomized control trials

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作者：
Zhang, Q.[1,2] * ; Liu, N.[3] * ; Li, Y.[1,2] ; Guo, J. -y.[1,2] ; Huang, Q. -s.[1,2] ; Cao, H.[1,2] ; Yin, Z. -q.[1,2] ; Liu, M. -y.[5] ; Wang, Z. -y.[1,2] ; Qi, S. -j.[3] ; Fang, M. -x.[1,2] ;
机构： [1]Department of Critical Care Medicine, The Third Hospital of Hebei Medical University, Hebei, China [2]Critical Disease Data Analysis and Intelligent Diagnosis and Treatment Engineering Research Center of Hebei Province, The Third Hospital of Hebei Medical University, Hebei, China [3]Department of Emergency, The Fourth Hospital of Hebei Medical University, Hebei, China [4]The Third Hospital of Hebei Medical University, Hebei, China [5]The First Hospital of Hebei Medical University, Hebei, China
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关键词： Acute Respiratory Distress Syndrome Mechanical ventilation Transpulmonary pressure Positive end-expiratory pressure Ventilation-induced lung injury Meta-analysis

摘要：
OBJECTIVE: This study aimed to investigate the effect of mechanical ventilation guided by transpulmonary pressure in patients diagnosed with acute respiratory distress syndrome (ARDS).MATERIALS AND METHODS: Randomized control trials of ARDS patients that received mechanical ventilation guided by transpulmonary pressure vs. mechanical ventilation guided by traditional lung protective ventilation strategies in adults were retrieved by two reviewers independently from PubMed, EMBASE, The Cochrane Library, The China National Knowledge Infrastructure, and Wan Fang database before October 2022. The protocol has been registered on PROSPERO (CRD42022307816). The primary outcome was mortality. The secondary outcomes included mechanical ventilation days, oxygenation function and ventilation parameters, hemodynamics, and cytokines level.RESULTS: Thirteen articles (819 patients) were finally included through our search strategy. The total mortality (RR, 0.68; 95% CI, 0.540.8 5; p = 0.0006) and mechanical ventilation days (MD,-2.77; 95% CI,-4.60 --0.94; p = 0.003) reduced when compared with the control group. Patients in the transpulmonary pressure group had higher oxygen index (MD, 40.74; 95% CI 9.81-71.68, p = 0.010) and lung compliance (MD, 7.98; 95% CI 4.55-11.41, p < 0.00001). Positive end-expiratory pressure (PEEP) was higher in the transpulmonary pressure group (MD, 5.47; 95% CI, 3.59 7.35; p < 0.00001). The Interlukin-6(IL-6) level in the control group decreased obviously compared with that in the transpulmonary pressure group (SMD,-2.03; 95% CI,-3.50 --0.56; p = 0.007).CONCLUSIONS: Mechanical ventilation guided by transpulmonary pressure tended to have a beneficial prognosis on ARDS patients. Oxygenation and lung mechanics parameters were also improved. The clinical effect of mechanical ventilation directed by transpulmonary pressure was superior to the traditional lung protective ventilation strategies in ARDS patients.

基金：
Heibei Department of Science and Technology [20377725D]; Program of Hebei Province to introduce overseas students [C20210353]; High-level talents funding Program of Hebei Province [A20203005]; Postgraduate Innovation Ability Training Program of Hebei Medical University
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出版当年[2023]版：
大类 | 4 区 医学
小类 | 4 区 药学
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无

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第一作者：
第一作者机构： [1]Department of Critical Care Medicine, The Third Hospital of Hebei Medical University, Hebei, China [2]Critical Disease Data Analysis and Intelligent Diagnosis and Treatment Engineering Research Center of Hebei Province, The Third Hospital of Hebei Medical University, Hebei, China
共同第一作者：
通讯作者：
通讯机构： [1]Department of Critical Care Medicine, The Third Hospital of Hebei Medical University, Hebei, China [2]Critical Disease Data Analysis and Intelligent Diagnosis and Treatment Engineering Research Center of Hebei Province, The Third Hospital of Hebei Medical University, Hebei, China
推荐引用方式(GB/T 7714)：
Zhang Q.,Liu N.,Li Y.,et al.Effect of mechanical ventilation guided by transpulmonary pressure in acute respiratory distress syndrome patients: a systematic review and meta-analysis of randomized control trials[J].EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES.2023,27(15):7020-7030.
APA：
Zhang, Q.,Liu, N.,Li, Y.,Guo, J. -y.,Huang, Q. -s....&Fang, M. -x..(2023).Effect of mechanical ventilation guided by transpulmonary pressure in acute respiratory distress syndrome patients: a systematic review and meta-analysis of randomized control trials.EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES,27,(15)
MLA：
Zhang, Q.,et al."Effect of mechanical ventilation guided by transpulmonary pressure in acute respiratory distress syndrome patients: a systematic review and meta-analysis of randomized control trials".EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 27..15(2023):7020-7030

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