Goal-Directed Mechanical Ventilation: Are We Aiming at the Right Goals? A Proposal for an Alternative Approach Aiming at Optimal Lung Compliance, Guided by Esophageal Pressure in Acute Respiratory Failure
Table 2
Meta-analysis studies of ARDS ventilation and strategies (last year 10 year-humans) years 2000–2012.
Author/year/ref
ARDS-Mechanical ventilation strategies
Major results
Study limitations
Recommendations
Burns et al., 2011 [26]
Petrucci and Iacovelli, 2007 [27]
Pressure and volume limited ventilation
PVL strategies reduce mortality. Mortality is significantly reduced at day 28 and at the end of hospital stay. Increment of paralytic agents.
Clinical heterogeneity, such as different lengths of follow-up and higher plateau pressure in control arms in two trials, make the interpretation of the combined results difficult.
There was insufficient evidence concerning morbidity and long term outcomes.
Available evidence from a limited number of RCTs shows better outcomes with routine use of low VT but not high PEEP ventilation in unselected patients with ARDS or acute lung injury.
limited number of RCTs
Best outcomes with routine use of low VT but not with high PEEP.
Recruitment maneuvers significantly increased oxygenation above baseline levels for a short period of time in four of the five studies that measured oxygenation.
There were insufficient data on length of ventilation or hospital stay to pool results.
There is no evidence to make conclusions on whether recruitment maneuvers reduce mortality or length of ventilation in patients with ALI or ARDS.
