Assessment of Therapeutic Interventions and Lung Protective Ventilation in Patients With Moderate to Severe Acute Respiratory Distress Syndrome

Abstract

Key Points Question What is the relative association of management strategies for adult patients with moderate to severe acute respiratory distress syndrome with mortality and barotrauma? Findings In this systematic review and network meta-analysis of 25 randomized clinical trials including 7743 patients, venovenous extracorporeal membrane oxygenation and prone positioning were associated with significantly lower 28-day mortality compared with lung protective ventilation alone. Moreover, venovenous extracorporeal membrane oxygenation was the highest-ranked intervention associated with a reduction in 28-day mortality among the 9 interventions evaluated. Meaning These findings support the use of prone positioning in patients with moderate to severe acute respiratory distress syndrome and venovenous extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome.