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.
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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)
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Chemical References |
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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
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