Efficacy of airway pressure release ventilation in patients with acute respiratory distress syndrome: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2022.02.009

Abstract

Abstract:

Objective

To evaluate the efficacy of airway pressure release ventilation (APRV) in patients with acute respiratory distress syndrome (ARDS).

Methods

The randomized controlled trials (RCTs) about the APRV and conventional mechanical ventilation for the treatment of ARDS patients were retrieved from Cochrane Library, PubMed, Embase, CBM, CNKI, Wangfang databases published up to March 2021. According to the inclusion and exclusion criteria, two researchers shifted the literatures, extracted the data and evaluated the methodological quality of the studies. Meta-analysis was performed using RevMan 5.2 software and Stata 1.4 software.

Results

A total of 11 RCTs were included in this study with 611 patients. The results of meta-analysis showed that the oxygenation index in the APRV group was much higher than that in the control group [mean difference (MD) = 31.70, 95% confidence interval (CI) (3.76, 59.63), Z = 2.22, P = 0.03], while the 28-day mortality was much lower[odds ratio (OR) = 0.55, 95% CI (0.36, 0.84), Z = 2.77, P = 0.006].

Conclusion

For the patients with ARDS, early application of APRV can improve oxygenation and reduce 28-day mortality.

Key words: Respiratory distress syndrome, Airway pressure release ventilation, Meta-analysis

Qiuyan Ren, Junhai Zhen, Liang Wu. Efficacy of airway pressure release ventilation in patients with acute respiratory distress syndrome: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(02): 135-140.

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Figures/Tables 4

References 34

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纳入研究	国家	样本量（例）	男/女（例）	年龄[岁，± s或M（P₂₅，P₇₅]		结局指标
纳入研究	国家	样本量（例）	男/女（例）	APRV组	对照组	结局指标
Zhou等^[12]	中国	138	91/47	51.5 ± 15.0	52.0 ± 15.1	氧合指数和28 d病死率
Li等^[13]	中国	52	-	54.3 ± 8.4	53.6 ± 9.5	氧合指数和28 d病死率
周志向^[14]	中国	60	33/27	51.78 ± 2.12	52.03 ± 2.04	氧合指数和28 d病死率
宋邵华等^[15]	中国	62	43/19	69（48，80）	71（52，86）	氧合指数
宋邵华等^[16]	中国	22	13/9	63（40，73）	73（53，80）	氧合指数
Grover等^[17]	美国	22	-	33 ± 12	-	氧合指数和28 d病死率
Ota等^[18]	美国	57	-	-	-	氧合指数和28 d病死率
Varpula等^[19]	芬兰	58	39/19	50.0（38.5，60.5）	44.0（35.5，53.0）	氧合指数和28 d病死率
Varpula等^[20]	芬兰	33	25/8	50.0（37.0，60.0）	46.5（37.2，55.3）	28 d病死率
李嘉文等^[21]	中国	32	-	33 ± 13	36 ± 14	氧合指数和28 d病死率
周立新等^[22]	中国	75	38/37	45 ± 12	43 ± 15	氧合指数

纳入研究	国家	样本量（例）	男/女（例）	年龄[岁，± s或M（P₂₅，P₇₅]		结局指标
纳入研究	国家	样本量（例）	男/女（例）	APRV组	对照组	结局指标
Zhou等^[12]	中国	138	91/47	51.5 ± 15.0	52.0 ± 15.1	氧合指数和28 d病死率
Li等^[13]	中国	52	-	54.3 ± 8.4	53.6 ± 9.5	氧合指数和28 d病死率
周志向^[14]	中国	60	33/27	51.78 ± 2.12	52.03 ± 2.04	氧合指数和28 d病死率
宋邵华等^[15]	中国	62	43/19	69（48，80）	71（52，86）	氧合指数
宋邵华等^[16]	中国	22	13/9	63（40，73）	73（53，80）	氧合指数
Grover等^[17]	美国	22	-	33 ± 12	-	氧合指数和28 d病死率
Ota等^[18]	美国	57	-	-	-	氧合指数和28 d病死率
Varpula等^[19]	芬兰	58	39/19	50.0（38.5，60.5）	44.0（35.5，53.0）	氧合指数和28 d病死率
Varpula等^[20]	芬兰	33	25/8	50.0（37.0，60.0）	46.5（37.2，55.3）	28 d病死率
李嘉文等^[21]	中国	32	-	33 ± 13	36 ± 14	氧合指数和28 d病死率
周立新等^[22]	中国	75	38/37	45 ± 12	43 ± 15	氧合指数

纳入研究	随机方法	分配隐藏	研究人员和受试者设盲	结果测量者设盲	结果数据的完整性	选择性报告研究结果	其他偏倚来源
Zhou等^[12]	信封法	是	否	-	是	否	不清楚
Li等^[13]	随机数表法	是	否	-	是	否	不清楚
周志向^[14]	随机数表法	-	否	-	是	否	不清楚
宋邵华等^[15]	-	-	否	-	是	否	不清楚
宋邵华等^[16]	随机数表法	-	否	-	是	否	不清楚
Grover等^[17]	-	-	否	-	是	否	不清楚
Ota等^[18]	-	-	否	-	是	否	不清楚
Varpula等^[19]	信封法	是	否	-	是	否	不清楚
Varpula等^[20]	-	-	否	-	是	否	不清楚
李嘉文等^[21]	随机数表法	-	否	-	是	否	不清楚
周立新等^[22]	-	-	否	-	是	否	不清楚

纳入研究	随机方法	分配隐藏	研究人员和受试者设盲	结果测量者设盲	结果数据的完整性	选择性报告研究结果	其他偏倚来源
Zhou等^[12]	信封法	是	否	-	是	否	不清楚
Li等^[13]	随机数表法	是	否	-	是	否	不清楚
周志向^[14]	随机数表法	-	否	-	是	否	不清楚
宋邵华等^[15]	-	-	否	-	是	否	不清楚
宋邵华等^[16]	随机数表法	-	否	-	是	否	不清楚
Grover等^[17]	-	-	否	-	是	否	不清楚
Ota等^[18]	-	-	否	-	是	否	不清楚
Varpula等^[19]	信封法	是	否	-	是	否	不清楚
Varpula等^[20]	-	-	否	-	是	否	不清楚
李嘉文等^[21]	随机数表法	-	否	-	是	否	不清楚
周立新等^[22]	-	-	否	-	是	否	不清楚

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