An Open Lung Strategy in the Management of Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

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An open lung strategy (OLS) that includes positive end expiratory pressure and recruitment maneuvers during mechanical ventilation is probably an important treatment method in patients with acute respiratory distress syndrome (ARDS). However, the effect of OLS is unknown. We therefore hypothesized that patients with ARDS may benefit from OLS treatment.


We identified relevant randomized controlled trials by searching through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials updated to May 22, 2016. We performed a systematic review and meta-analysis to evaluate the effect of OLS in patients with ARDS. The primary outcome was mortality.


A total of 15 randomized controlled trials involving 1,563 patients in OLS group and 1,571 patients in control group were included. Pooled analysis showed that there was significant difference in hospital mortality (relative risk [RR], 0.88; 95% CI, 0.80–0.97; P = 0.009), 28-day mortality (RR, 0.83; 95% CI, 0.71–0.96; P = 0.010), and intensive care unit (ICU) mortality (RR, 0.77; 95% CI, 0.65–0.92; P = 0.003) between the OLS group and control group, with no substantial heterogeneity. There was no significant difference in ventilator-free days at 28-day (mean difference [MD]; 3.32 d; 95% CI, −0.49 to 7.12; P = 0.09) and ICU length of stay (MD; 1.60 d; 95% CI, −2.99 to 6.20; P = 0.49) between OLS group and control group.


Results from this systematic review and meta-analysis suggest that OLS during mechanical ventilation significantly reduces mortality among patients with ARDS.

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