To evaluate the effectiveness of airway pressure release ventilation in patients with acute respiratory distress syndrome.

We searched the US National Library of Medicine PubMed database, Web of Science, Cochrane Library Database, China Knowledge Network, China Biomedical Literature Database, VIP and Wanfang Database for randomized controlled clinical trials published before December 31, 2019 on the efficacy of APRV in patients with ARDS, in which the control groups used conventional mechanical ventilation, and the experimental groups used airway pressure release ventilation; outcomes included hospital mortality, ICU hospitalization time, lung compliance, oxygenation index, and mean airway pressures. The quality of the selected literature was evaluated by two professionally trained evidence-based medicine researchers.Meta-analysis was performed on the literature that met the quality criteria. The sequential analysis method was used to evaluate the sample size of the hospitalized mortality rate of ARDS patients treated with APRV.

Eight articles were selected and 461 patients were enrolled, with 232 in the APRV group and 229 in the CV group. The results showed that APRV can reduce the mortality of patients with acute respiratory distress syndrome (OR=0.63, 95% CI=0.40~0.97, P=0.04). The TSA results show that in order to avoid the occurrence of false positive results further research is needed, the clinical sample size should be expanded to verify the reliability of the results; APRV can shorten the ICU stay of ARDS patients (OR=-4.14, 95%CI=-6.81~-1.47, P=0.002); APRV can improve Pulmonary compliance in patients with ARDS (MD=5.12, 95%CI=0.33~9.91, P=0.04); but there was no difference in improving oxygenation and mean airway pressure between the two groups.

APRV can decrease the mortality of ARDS patients, shorten their ICU stay, and improve their lung compliance. There is not any difference in improving oxygenation and mean airway pressure between the two groups.