DOI: 10.36347/sajp.2012.v01i01.007

Pages: 34-39

Background: Studies contrasting higher and lower PEEP in individuals with ALI have not been sufficiently powered to examine differences or identify subtle but potentially significant impacts on mortality. Our objective was to evaluate the association between high versus low PEEP and patient-important outcomes in individuals with ALI receiving low TVs ventilation. Method: The PRISMA statement was followed in the course of this systematic review investigation. Randomized trials that qualified for this review examined higher and lower PEEP levels in critically ill patients diagnosed with ALI. To locate relevant trials, we performed an electronic search of MEDLINE, Cochrane, and EMBASE (all from 2000 to 2011). We only included English-language randomized controlled trials. Results: Four trials yielded 2394 patients met our eligibility criteria. In the Assessment of Low TV and Elevated End-Expiratory Pressure to ALI and the Lung Open Ventilation to Reduce Mortality in the ARDS, PEEP levels were titrated to oxygenation using equivalent PEEP to FIO2 charts. The Expiratory Pressure Study's experimental strategy titrated PEEP levels based on plateau pressure data, regardless of the effect on oxygenation. Conclusion: Higher PEEP levels associated with a lower hospital death rate in patients with ARDS. Additionally, our findings suggest that this is unlikely to be beneficial for patients with less severe lung injuries; in fact, treating these patients with high PEEP levels may be harmful.