Objective: The "Open Lung Approach" (OLA), that includes high levels of positive end-expiratory pressure coupled with limited tidal volumes, is considered optimal for adult patients with ARDS. However, many previous meta-analyses have shown only marginal benefits of OLA on mortality but with statistical heterogeneity. It is crucial to identify the most likely moderators of this effect. To determine the effect of OLA strategy on mortality of ventilated ARDS patients. We hypothesized that the degree of recruitment achieved in the control group (PaO/FiO ratio on day 3 of ventilation), and the difference in Mechanical Power (MP) or Driving Pressure (DP) between experimental and control groups will be the most likely sources of heterogeneity.
Design: A Systematic Review and Meta-analysis was performed according to PRISMA statement and registered in PROSPERO database. We searched only for randomized controlled trials (RCTs). GRADE guidelines were used for rating the quality of evidence. Publication bias was assessed. For the Meta-analysis, we used a Random Effects Model. Sources of heterogeneity were explored with Meta-Regression, using a priori proposed set of possible moderators. For model comparison, Akaike's Information Criterion with the finite sample correction (AICc) was used.
Setting: Not applicable.
Patients: Fourteen RCTs were included in the study.
Interventions: Not applicable.
Main Variables Of Interest: Not applicable.
Results: Evidence of publication bias was detected, and quality of evidence was downgraded. Pooled analysis did not show a significant difference in the 28-day mortality between OLA strategy and control groups. Overall risk of bias was low. The analysis detected statistical heterogeneity. The two "best" explicative meta-regression models were those that used control PaO/FiO on day 3 and difference in MP between experimental and control groups. The DP and MP models were highly correlated.
Conclusions: There is no clear benefit of OLA strategy on mortality of ARDS patients, with significant heterogeneity among RCTs. Mortality effect of OLA is mediated by lung recruitment and mechanical power.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.medine.2021.03.001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Advances in human papillomavirus detection for cervical cancer screening and diagnosis: challenges of conventional methods and opportunities for emergent tools.
Anal Methods
January 2025
Molecular Science Institute, School of Chemistry, University of the Witwatersrand, Johannesburg 2050, South Africa.
Human papillomavirus (HPV) infection is the main cause of cervical cancer and other cancers such as anogenital and oropharyngeal cancers. The prevention screening and treatment of cervical cancer has remained one of the top priorities of the World Health Organization (WHO). In 2020, the WHO came up with the 90-70-90 strategy aimed at eliminating cervical cancers as a public health problem by the year 2030.
View Article and Find Full Text PDFArticle Synopsis
- CAR T-cell therapy shows strong initial results for treating relapsed refractory multiple myeloma, but most patients eventually relapse, often within 5 months.
- In a study of 139 patients who relapsed after CAR T-cell therapy, different salvage therapies were analyzed, revealing that bispecific antibodies, like talquetamab and teclistamab, had the best overall and complete response rates.
- The presence of extramedullary disease at relapse was linked to poorer outcomes, but bispecific antibodies improved survival rates, suggesting they should be the standard treatment for patients relapsing after CAR T-cell therapy.
Integrated miRNA-seq and functional analyses reveal the regulatory role of sha-miR-92a_L + 2R + 4 via targeting vegfaa in rainbow trout (Oncorhynchus mykiss) responding to acute hypoxia and reoxygenation stress.
BMC Genomics
December 2024
College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, 730070, China.
Background: Hypoxia negatively affects the behavior, growth, reproduction and survival of fish, causing serious economic losses to aquaculture. Rainbow trout (Oncorhynchus mykiss), an important economic fish worldwide, belongs to a hypoxia-sensitive fish species, however, little is known about the regulatory mechanism of microRNAs (miRNAs) under hypoxia stress.
Results: Rainbow trout were subjected to hypoxia stress for 3 h (H3h_L), 12 h (H12h_L), 24 h (H24h_L) and 3 h reoxygenation (R3h_L) to systemically evaluate the changes of miRNA expression profiles in liver, and functions of sha-miR-92a_L + 2R + 4 were investigated.
Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple myeloma (MM) and related disorders. MGUS is characterized by asymptomatic paraproteinemia. In some cases, multiple paraproteins can be identified but the clinical implications of this phenomenon are poorly understood.
View Article and Find Full Text PDFImplications of crystal disorder on the solid-state stability of olanzapine.
J Pharm Sci
January 2025
Research Center Pharmaceutical Engineering GmbH (RCPE), 8010 Graz, Austria; Graz University of Technology, Institute of Process and Particle Engineering, 8010 Graz, Austria. Electronic address:
Mechanical perturbations of drug during solid pharmaceutical processing like milling can often generate crystal disorder posing serious implications to drug's stability. While physical changes like amorphization, recrystallization, polymorphism of the disordered drugs are extensively studied and reported in the literature, the propensities and inter-dependencies of recrystallization and degradation of disordered drugs have seldom received deep attention. Previous investigations from our lab have explored some of these interplays, aiming to develop predictive stability models.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!