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July 22, 2004

Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome.

Mazen Kherallah

Summarized by: 

What was the research question?

  • Does high PEEP improve the in-hospital mortality rate or the ventilator-free days in ARDS patients ventilated with low tidal volume and limited plateau pressure <30, compared to low PEEP?

How did they do it?

  • Multicenter, randomized trial in 23 across the USA.

  • 549 patients with acute lung injury and ARDS (PaO2:FiO2 of <300).

  • Patients were randomized to receive high versus low PEEP strategy based on FiO2/PEEP table of ARDSnet trial.

  • Both groups received low tidal volume ventilation with 6 ml/kg/breath (ideal body weight) and plateau pressure < 30 cm water.

  • Primary outcome was in-hospital mortality and secondary was number ventilator-free days on day 28.

What did they find?

  • High PEEP strategy did not reduce in-hospital mortality compared to low PEEP (24.9 vs 27.5.8% vs 31.0%, p=0.007).

  • The mean number of ventilator-free days were similar in the two groups (13.8±10.6 days in the higher-PEEP group vs 14.5±10.4 days in the lower-PEEP, P=0.50).

What does it mean?

  • In patients with acute lung injury or ARDS, a ventilation strategy with higher PEEP did not improve in-hospital mortality or ventilator-free days compared to low PEEP in ARDS patients with volume ventilation of 6 mL/kg of ideal body weight and limited plateau pressure of ≤ 30 cmH2O.


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