{"id":19638,"date":"2020-12-23T05:27:00","date_gmt":"2020-12-22T21:27:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19638"},"modified":"2020-12-25T06:18:34","modified_gmt":"2020-12-24T22:18:34","slug":"jama%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9a%e4%bd%8epeep%e4%b8%8e%e9%ab%98peep%e7%ad%96%e7%95%a5%e5%af%b9%e9%9d%9eards%e7%9a%84icu%e6%82%a3%e8%80%85%e6%97%a0%e6%9c%ba%e6%a2%b0%e9%80%9a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19638","title":{"rendered":"[JAMA\u5728\u7ebf\u53d1\u8868]\uff1a\u4f4ePEEP\u4e0e\u9ad8PEEP\u7b56\u7565\u5bf9\u975eARDS\u7684ICU\u60a3\u8005\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation\u00a0Caring for the Critically Ill Patient<\/p>\n\n\n\n

Effect of a Lower vs Higher Positive End-Expiratory Pressure Strategy on Ventilator-Free Days in ICU Patients Without ARDS: A Randomized Clinical Trial<\/h1>\n\n\n\n

Writing Committee and Steering Committee for the RELAx Collaborative Group<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online December 9, 2020. doi:10.1001\/jama.2020.23517<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong><\/h3>\n\n\n\n

It is uncertain whether invasive ventilation can use lower positive end-expiratory pressure (PEEP) in critically ill patients without acute respiratory distress syndrome (ARDS).<\/p>\n\n\n\n

Objective<\/strong><\/h3>\n\n\n\n

To determine whether a lower PEEP strategy is noninferior to a higher PEEP strategy regarding duration of mechanical ventilation at 28 days.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong><\/h3>\n\n\n\n

Noninferiority randomized clinical trial conducted from October 26, 2017, through December 17, 2019, in 8 intensive care units (ICUs) in the Netherlands among 980 patients without ARDS expected not to be extubated within 24 hours after start of ventilation. Final follow-up was conducted in March 2020.<\/p>\n\n\n\n

Interventions<\/strong><\/h3>\n\n\n\n

Participants were randomized to receive invasive ventilation using either lower PEEP, consisting of the lowest PEEP level between 0 and 5 cm H2<\/sub>O (n\u2009=\u2009476), or higher PEEP, consisting of a PEEP level of 8 cm H2<\/sub>O (n\u2009=\u2009493).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong><\/h3>\n\n\n\n

The primary outcome was the number of ventilator-free days at day 28, with a noninferiority margin for the difference in ventilator-free days at day 28 of \u221210%. Secondary outcomes included ICU and hospital lengths of stay; ICU, hospital, and 28- and 90-day mortality; development of ARDS, pneumonia, pneumothorax, severe atelectasis, severe hypoxemia, or need for rescue therapies for hypoxemia; and days with use of vasopressors or sedation.<\/p>\n\n\n\n

Results<\/strong><\/h3>\n\n\n\n

Among 980 patients who were randomized, 969 (99%) completed the trial (median age, 66 [interquartile range {IQR}, 56-74] years; 246 [36%] women). At day 28, 476 patients in the lower PEEP group had a median of 18 ventilator-free days (IQR, 0-27 days) and 493 patients in the higher PEEP group had a median of 17 ventilator-free days (IQR, 0-27 days) (mean ratio, 1.04; 95% CI, 0.95-\u221e;\u00a0P<\/em>\u2009=\u2009.007 for noninferiority), and the lower boundary of the 95% CI was within the noninferiority margin. Occurrence of severe hypoxemia was 20.6% vs 17.6% (risk ratio, 1.17; 95% CI, 0.90-1.51;\u00a0P<\/em>\u2009=\u2009.99) and need for rescue strategy was 19.7% vs 14.6% (risk ratio, 1.35; 95% CI, 1.02-1.79; adjusted\u00a0P<\/em>\u2009=\u2009.54) in patients in the lower and higher PEEP groups, respectively. Mortality at 28 days was 38.4% vs 42.0% (hazard ratio, 0.89; 95% CI, 0.73-1.09;\u00a0P<\/em>\u2009=\u2009.99) in patients in the lower and higher PEEP groups, respectively. There were no statistically significant differences in other secondary outcomes.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong><\/h3>\n\n\n\n

Among patients in the ICU without ARDS who were expected not to be extubated within 24 hours, a lower PEEP strategy was noninferior to a higher PEEP strategy with regard to the number of ventilator-free days at day 28. These findings support the use of lower PEEP in patients without ARDS.<\/p>\n\n\n\n

Trial Registration<\/strong><\/h3>\n\n\n\n

ClinicalTrials.gov Identifier:\u00a0NCT03167580<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0Caring for the Critically Ill Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19638"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19638"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19638\/revisions"}],"predecessor-version":[{"id":19639,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19638\/revisions\/19639"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19638"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19638"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19638"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}