Evidence map›Paper›PMID 34384488›Full record

ArticleSystematic reviews2021

Association of different positive end-expiratory pressure selection strategies with all-cause mortality in adult patients with acute respiratory distress syndrome.

Manuel Tisminetzky, Jose Dianti, Bruno L Ferreyro, Federico Angriman, Lorenzo Del Sorbo, Sachin Sud, Daniel Talmor, Eddy Fan, Niall D Ferguson, Ary Serpa Neto and 2 more

Abstract read
In one paragraph

Article in Systematic reviews, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Manuel Tisminetzky *University Health Network/Sinai Health System, University of Toronto, Toronto, Canada.
Jose Dianti *University Health Network/Sinai Health System, University of Toronto, Toronto, Canada.
Bruno L FerreyroUniversity Health Network/Sinai Health System, University of Toronto, Toronto, Canada.
Federico AngrimanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Lorenzo Del SorboInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Sachin SudInstitute for Better Health and Critical Care, Department of Medicine, Trillium Health Partners, Mississauga, Canada.
Daniel TalmorDepartment of Anesthesia, Pain, Medicine and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Eddy FanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Niall D FergusonInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Ary Serpa NetoHospital Israelita Albert Einstein, São Paulo, Brazil.
Neill K J AdhikariInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Ewan C GoligherUniversity Health Network/Sinai Health System, University of Toronto, Toronto, Canada. ewan.goligher@uhn.ca.

Funding

CIHR
6 · The paper itself

Abstract

backgroundThe acute respiratory distress syndrome (ARDS) has high morbidity and mortality. Positive end-expiratory pressure (PEEP) is commonly used in patients with ARDS but the best method to select the optimal PEEP level and reduce all-cause mortality is unclear. The primary objective of this network meta-analysis is to summarize the available evidence and to compare the effect of different PEEP selection strategies on all-cause mortality in adult patients with ARDS.

methodsWe will search MEDLINE, Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and LILACS from inception onwards for randomized controlled trials assessing the effect of PEEP selection strategies in adult patients with moderate to severe ARDS. We will exclude studies that did not use a lung-protective ventilation approach as part of the comparator or intervention strategy. The primary outcome will be all-cause mortality (at the longest available follow-up and up to 90 days). Secondary outcomes will include barotrauma, ventilator-free days, intensive care unit and hospital length of stay, and changes in oxygenation. Two reviewers will independently screen all citations, full-text articles, and extract study-data. We will assess the risk of bias for each of the outcomes using version 2 of the Cochrane risk of bias tool for randomized controlled trials. If feasible, Bayesian network meta-analyses will be conducted to obtain pooled estimates of all potential head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and risk differences, together with the associated 95% credible intervals. We will assess certainty in effect estimates using GRADE methodology. DISCUSSION: The present study will inform clinical decision-making for adult patients with ARDS and will improve our understanding of the limitations of the available literature assessing PEEP selection strategies. Finally, this information may also inform the design of future randomized trials, including the selection of interventions, comparators, and predictive enrichment strategies.

trial registrationPROSPERO 2020 CRD42020193302 .

Indexed as

Respiratory Distress SyndromeAdultBayes TheoremHumansIntensive Care UnitsNetwork Meta-Analysis as TopicPositive-Pressure RespirationRandomized Controlled Trials as TopicResearch DesignRespiration, ArtificialAcute respiratory distress syndromeARDSBarotraumaHypoxemic respiratory failureLung recruitment maneuverPEEPPositive end-expiratory pressure

Identifiers

PMID34384488
PMCPMC8357961

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.