Comparison The Clinical Effectiveness Of Sustained Inflation And Pressure Controlled Ventilation In The Treatment Of ARDS:A Systematic Review And Meta-analysis

Objective:The aim of this study was to systematically review the clinical efficacy of sustained inflation and pressure controlled ventilation in the treatment of ARDS,to provide a more reasonable and scientific evidence-based medicine for clinical application of the treatment of ARDS.Materials and Methods:We fully searched for randomized controlled trials（RCTs）and randomized cross-over trials in the following databases:Pubmed（1950²016.9）、Cochrane Library（1948²016.9）、EMBase（1980²016.9）、Web of Science（1970²016.9）、SinoMed（1978²016.9）、CNKI（1994²016.9）、VIP database（1989²016.9）、Wanfang medical database（1998²016.9）and hand searched Chinese Clinical Trail Register、ClinicalTrails.gov、ARDS.Network、Chinese Critical Care Medicine（1989²006）and Chinese Journal of Respiratory and Critical Care Medicine（2002²016）.Two reviewers assessed the quality of studies and extracted data independently.Meta-analysis was done by Revman5.3.As to continuous data,we calculated MD or SMD and its 95%confidence intervals.Results:Thirteen trials involving 540 patients were included in the systematic review.Both of the two recruitment maneuvers（RMs）can improve PaO₂/FiO₂、Cst and FRC.（1）PaO₂/FiO₂（P/F）:There were no significant differences on improving P/F between the two methods after5min,15min and 2h（P>0.05）.PCV was better than SI on improving P/F after 30min and 1h（P<0.05）.（2）FRC:There were no significant differences on improving FRC between the two methods after 5min and 1h（P>0.05）.（3）:Cst:There were no significant differences between the two methods after 5min,30min and 2h（P>0.05）.PCV was better than SI on improving Cst after 1h（P<0.05）.Both of the two RMs accelerated HR and CVP,and decreased MAP and CI within a short period.（4）HR:PCV was lower than SI on the increase of HR after 5min and 10min and during RM（P<0.05）.There were no significant differences on ithe increase of HR betweenthetwomethodsafter15min,30minand1h（P>0.05）.（5）MAP:PCV was lower than SI on the decrease of MAP during RM（P<0.05）.There were no significant differences on the decrease of MAP between the two methods after 0min,5min,15min and 1h（P>0.05）.（6）CVP:There were no significant differences on the increase of CVP between the two methods after 0min,5min,10min and 30min（P>0.05）.（7）CI:PCV was lower than SI on the increase of CI during the RM（P<0.05）.There were no significant differences on the decrease of CI betweenthetwomethodsafter5minand1h（P>0.05）.（8）Echocardiographic assessment:Only one trial discribed the change of echocardiography after RMs.Both of the RM methods decreased LVEDA and LVESA,and the SI method was more obviously than PCV（P<0.05）.The Eccentricity index（EI）was higher than before in SI method.Conclusion:Both of the maneuvers can improve the P/F,Cst and FRC during RM,and PCV was superior to SI on improving P/F and Cst;There were no significant difference on improving FRC during two RMs.Both of the maneuvers were observed transient hemodynamic changes during RM,and PCV on hemodynamics change was less than SI.However,due to the limited literature and sample size,the conclusion should be treated with caution.So well-designed and large sample size RCTS should be carried out for the futher evaluation in the future.