Positive end-expiratory pressure, prone positioning, and activated protein C: a critical review of meta-analyses.

Abstract

The results of meta-analyses on the effectiveness of high positive end-expiratory pressure (PEEP) and prone positioning in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) are not consistent. In addition, the meta-analyses on the activated protein C in patients with sepsis combine trials with discordant results. Therefore, the aim of this paper was to give a critical review of these meta-analyses. All relevant meta-analyses were identified by a computerized search of PubMed using combinations of the following terms: acute lung injury, acute respiratory distress syndrome, positive end-expiratory pressure, mechanical ventilation, prone position, drotrecogin, activated protein C, sepsis, and septic patients. A high level of PEEP and prone ventilation was shown to reduce the mortality in patients with severe acute hypoxemic respiratory failure. Although the evidence for the efficacy of activated protein C is not conclusive, it should be considered in patients that are at a high risk for death without any contraindications related to bleeding risk. Meta-analysis models can be very useful for clinical decisions if they include all of the similar papers on a medical topic and are correct from the methodological point of view; however, these results must be checked by a careful and well-informed reader.

• Authors: B M Cesana, P Antonelli, D Chiumello, L Gattinoni
• Journal: Minerva anestesiologica (Minerva Anestesiol) Vol. 76 Issue 11 Pg. 929-36 (Nov 2010) ISSN: 1827-1596 [Electronic] Italy
• PMID: 21102388 (Publication Type: Journal Article, Meta-Analysis, Review)

Chemical References

• Protein C

Topics

• Acute Lung Injury (therapy)
• Humans
• Positive-Pressure Respiration (methods)
• Prone Position (physiology)
• Protein C (therapeutic use)
• Respiratory Distress Syndrome (therapy)
• Sepsis (drug therapy)
• Survival