Higher versus lower positive end-expiratory pressure in acute lung injury and acute respiratory distress syndrome: systematic review and individual patient data meta-analysis

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Abstract

PaO 2 /FiO 2 ≤150 also had their extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) monitored using the PiCCO system (Pulsion, Munich, Germany) when required by their attending physician.Statistical analysis was performed using the Spearman correlation coeffi cient (R s ) with P ≤0.05 assumed to be signifi cant.Results Fourteen patients were enrolled in the study.In six of these patients, the EVLWi and PVPI were measured simultaneously.At baseline, the elastase level and the PVPI showed a strong and signifi cant correlation (R s = 1.000, n = 6, P <0.05).All of the plot data of the six patients showed strong correlations of the elastase level with the EVLWi (R s = 0.750, n = 25, P <0.01) and the PVPI (R s = 0.811, n = 25, P <0.01). ConclusionsThe plasma neutrophil elastase level and the PVPI measured by PiCCO were strongly correlated in patients with pneumonia.This suggests that a rise in the blood level of elastase may elevate the PVPI, resulting in an increased EVLWi.

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