Author Of 1 Presentation
OLA STRATEGY LOWERS MORTALITY OF VENTILATED ARDS PATIENTS, ALTHOUGH THE EFFECT DEPENDS ON LUNG RECRUITMENT (PAO2/FIO2) AND MECHANICAL POWER: SYSTEMATIC REVIEW AND META-ANALYSIS
Abstract
Background
Mechanical ventilation (MV) can produce VILI. “Open Lung Approach” (OLA) strategies could improve survival, but evidence is conflictive.
Objectives
Compare the clinical effectof a MV strategy aimed at maximising lung recruitmentin ARDS patients. And to see if this effect depends on the mechanical power (MP) transmitted to the lungs.
Methods
Systematic review and meta-analysis. We included RCTs of ARDS patients which included MV strategies aimed at maximising the lung recruited volume using high PEEP (OLA-group), versus standard strategies (CONTROL-group). RCTs of prone position or HFV were excluded. We used GRADE methodology. Random effects model was used to evaluate OLA strategy effect on 28 day Relative Risk of mortality (RR). A meta-regression was also performed with 3 candidate variables: PEEP level in OLA-group, recruitment (PaO2/FiO2) achieved in CONTROL-group, and relative MP/kg. The “best fit” model was the one with the minimum Akaike Information Criteria.
Results
Twelve RCTs (4,761 patients) were included. Mortality was significantly lower in OLA-group: RR = 0.86 (95% CI = 0.74 to 0.99; RE model). Quality of evidence was downgraded and there was no evidence of publication bias. The best model included PaO2/FiO2 of CONTROL-group and relative MP/kg. It shows that the effect of OLA disappears when the CONTROL-group has a PaO2/FiO2 > 170, and when relative MP/kg >= 1.
Conclusion
MV with OLA strategy improves mortality in ARDS patients. The effect vanishes when patients are already well recruited or when OLA strategy produces a higher energy transmission to the lungs.