Assessment of Therapeutic Interventions and Lung Protective Ventilation in Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Systematic Review and Network Meta-analysis

JAMA Network Open
Hiroko AoyamaEddy Fan

Abstract

A number of interventions are available to manage patients with moderate to severe acute respiratory distress syndrome (ARDS). However, the associations of currently available ventilatory strategies and adjunctive therapies with mortality are uncertain. To compare and rank different therapeutic strategies to identify the best intervention associated with a reduction in mortality in adult patients with moderate to severe ARDS. An electronic search of MEDLINE, MEDLINE In-Process/ePubs Ahead of Print, Embase, Cochrane Controlled Clinical Trial Register (Central), PubMed, and CINAHL was conducted, from database inception to May 29, 2019. Randomized clinical trials of interventions for adults with moderate to severe ARDS that used lung protective ventilation. No language restrictions were applied. Data were independently extracted by 2 reviewers and synthesized with Bayesian random-effects network meta-analyses. The primary outcome was 28-day mortality. Barotrauma was a secondary outcome. Among 25 randomized clinical trials evaluating 9 interventions, 2686 of 7743 patients (34.6%) died within 28 days. Compared with lung protective ventilation alone, prone positioning and venovenous extracorporeal membrane oxygenation were associated...Continue Reading

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Citations

Apr 29, 2020·American Journal of Respiratory and Critical Care Medicine·Christian KaragiannidisThomas Bein
Aug 2, 2020·Intensive Care Medicine·Graeme MacLarenDaniel Brodie
Jun 18, 2020·Thorax·David KoeckerlingG Andre Ng
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May 11, 2021·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·Sarvesh Pal Singh, Milind Padmakar Hote
Jun 22, 2021·Frontiers in Cardiovascular Medicine·Alvaro Petersen-UribeDominik Rath

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