Higher peep in patients with acute lung injury: A systematic review and meta-analysis

Elliott C. Dasenbrook, Dale M. Needham, Roy G. Brower, Fan Eddy

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


BACKGROUND: Studies of ventilation strategies that included higher PEEP in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) have yielded conflicting results. OBJECTIVE: To determine whether higher PEEP during volume-limited and pressure-limited ventilation is associated with 28-day mortality or barotrauma rates in patients with ALI/ARDS. METHODS: We searched MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and the bibliographies of retrieved papers to identify randomized controlled trials that compared higher and lower PEEP in adult patients with ALI/ARDS who were already receiving volume-limited or pressure-limited ventilation. Two of us independently abstracted study-level data, including study design, patient characteristics, study methods, intervention, and main results. We pooled the studylevel data with a random-effects model, unless heterogeneity was low (I2 < 50%), in which case we used a fixed-effects model. The primary outcome was 28-day mortality. RESULTS: Four randomized trials (2,360 participants) were evaluated. Higher PEEP had a nonsignificant trend toward lower 28-day mortality (pooled relative risk 0.90, 95% CI 0.79 -1.02). There was no difference in barotrauma between the 2 groups (pooled relative risk 1.17, 95% CI 0.90 -1.52). Two studies reported an adjusted hospital death rate, and the pooled results of sensitivity analysis with those adjusted rates were identical to those of the unadjusted analysis. CONCLUSIONS: In 4 recent studies that used volume-limited or pressure-limited ventilation in ALI/ARDS patients, higher PEEP was not associated with significantly different short-term mortality or barotrauma. This study does not support the routine use of higher PEEP in patients with ALI/ARDS.

Original languageEnglish (US)
Pages (from-to)568-575
Number of pages8
JournalRespiratory care
Issue number5
StatePublished - May 2011


  • Acute lung injury
  • Adult
  • Cute respiratory distress syndrome
  • Mechanical ventilation
  • Meta-analysis
  • Mortality
  • Randomized controlled trial
  • Review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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