NEJM
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.