Optimal plateau pressure for patients with acute respiratory distress syndrome: A protocol for a systematic review and meta-analysis with meta-regression

Hideto Yasuda, Tetsuro Nishimura, Tetsuro Kamo, Masamitsu Sanui, Eishu Nango, Takayuki Abe, Toru Takebayashi, Alan Kawarai Lefor, Satoru Hashimoto

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Introduction Lower tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS) is a strategy to reduce the plateau pressure and driving pressure to limit ventilator-induced lung injury (VILI). Several randomised controlled trials (RCTs) and meta-analyses showed that limiting both the plateau pressure and the tidal volume decreased mortality, but the optimal plateau pressure to demonstrate a benefit is uncertain. The aim of this systematic review is to investigate the optimal upper limit of plateau pressure in patients with ARDS to prevent VILI and improve clinical outcomes using meta-analysis with and without meta-regression. Methods and analysis: RCTs comparing two mechanical ventilation strategies will be included, with lower plateau pressure and with higher plateau pressure, among patients with ARDS and acute lung injury. Data sources include MEDLINE via the NCBI Entrez system, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Ichushi, a database of papers in Japanese. Two of three physicians will independently screen trials obtained by search for eligibility, and extract data from included studies onto standardised data recording forms. For each included trial, the risk of bias and the quality of evidence will be evaluated using the Grading of Recommendation Assessment Development and Evaluation system. Ethics and dissemination: This study does not require ethical approval. The results of this systematic review and meta-analysis with and without meta-regression will be disseminated through conference presentation and publication in a peer-reviewed journal.

Original languageEnglish
Article numbere015091
JournalBMJ Open
Volume7
Issue number5
DOIs
Publication statusPublished - 2017 May 1

Fingerprint

Adult Respiratory Distress Syndrome
Meta-Analysis
Pressure
Ventilator-Induced Lung Injury
Tidal Volume
Randomized Controlled Trials
Acute Lung Injury
Information Storage and Retrieval
Artificial Respiration
Ethics
MEDLINE
Publications
Databases
Physicians
Mortality

Keywords

  • acute respiratory distress syndrome
  • ARDS
  • mechanical ventilation
  • plateau pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Optimal plateau pressure for patients with acute respiratory distress syndrome : A protocol for a systematic review and meta-analysis with meta-regression. / Yasuda, Hideto; Nishimura, Tetsuro; Kamo, Tetsuro; Sanui, Masamitsu; Nango, Eishu; Abe, Takayuki; Takebayashi, Toru; Lefor, Alan Kawarai; Hashimoto, Satoru.

In: BMJ Open, Vol. 7, No. 5, e015091, 01.05.2017.

Research output: Contribution to journalReview article

Yasuda, Hideto ; Nishimura, Tetsuro ; Kamo, Tetsuro ; Sanui, Masamitsu ; Nango, Eishu ; Abe, Takayuki ; Takebayashi, Toru ; Lefor, Alan Kawarai ; Hashimoto, Satoru. / Optimal plateau pressure for patients with acute respiratory distress syndrome : A protocol for a systematic review and meta-analysis with meta-regression. In: BMJ Open. 2017 ; Vol. 7, No. 5.
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AB - Introduction Lower tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS) is a strategy to reduce the plateau pressure and driving pressure to limit ventilator-induced lung injury (VILI). Several randomised controlled trials (RCTs) and meta-analyses showed that limiting both the plateau pressure and the tidal volume decreased mortality, but the optimal plateau pressure to demonstrate a benefit is uncertain. The aim of this systematic review is to investigate the optimal upper limit of plateau pressure in patients with ARDS to prevent VILI and improve clinical outcomes using meta-analysis with and without meta-regression. Methods and analysis: RCTs comparing two mechanical ventilation strategies will be included, with lower plateau pressure and with higher plateau pressure, among patients with ARDS and acute lung injury. Data sources include MEDLINE via the NCBI Entrez system, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Ichushi, a database of papers in Japanese. Two of three physicians will independently screen trials obtained by search for eligibility, and extract data from included studies onto standardised data recording forms. For each included trial, the risk of bias and the quality of evidence will be evaluated using the Grading of Recommendation Assessment Development and Evaluation system. Ethics and dissemination: This study does not require ethical approval. The results of this systematic review and meta-analysis with and without meta-regression will be disseminated through conference presentation and publication in a peer-reviewed journal.

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