• Hongyu Yi, Xiaoming Li, Zhi Mao, Chao Liu, Xin Hu, Rengjie Song, Shuang Qi, and Feihu Zhou.
• Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China.
• J Crit Care. 2022 Feb 1; 67: 72-78.

PurposeTo evaluate the effects of high and low levels of PEEP on ICU patients without ARDS.MethodsWe searched public databases (including PubMed, EMBASE, Cochrane Library and Clinicaltrial.gov). The Cochrane Risk of Bias Assessment tool was used to evaluate the quality of the included studies.ResultsWe included 2307 patients from 24 trials. Although no significant difference was found between high and low PEEP applications in in-hospital mortality (risk ratio[RR] 0.98, 95% confidence interval[CI] [0.81, 1.19], P = 0.87), high PEEP indeed decreased the incidence of ARDS, hypoxemia, and increased the level of PaO2/FIO2. In addition, although the overall results did not reveal any advantages of high PEEP in terms of secondary outcomes regarding 28-day mortality, the duration of ventilation, atelectasis, pulmonary barotrauma, hypotension, and so forth, the subgroup analysis concerning the level of low PEEP (ZEEP or not) and patient type (postoperative or medical ones) yielded different results. The TSA results suggested that more RCTs are needed.ConclusionsAlthough ventilation with high PEEP in ICU patients without ARDS may not reduce in-hospital mortality, the decreased incidences of ARDS and hypoxemia and the improvement in PaO2/FIO2 were found in the high PEEP arm.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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