A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: A randomized, controlled trial*

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Key Points

This trial aims to determine if a ventilatory strategy using high PEEP and low tidal volume improves outcomes in patients with severe ARDS.
Randomized, controlled clinical trial conducted in eight Spanish ICUs.
Patients with ARDS and Pao2/Fio2 ≤200 mm Hg after standard settings were randomized to Pflex/LTV or control groups.
Control group used higher tidal volume (9-11 mL/kg) and lower PEEP (≥5 cm H2O) compared to Pflex/LTV (5-8 mL/kg and PEEP set at Pflex + 2 cm H2O).
ICU mortality was 53.3% in control vs. 32% in Pflex/LTV group (p = .040).
Hospital mortality was 55.5% in control vs. 34% in Pflex/LTV group (p = .041).
Ventilator-free days at day 28 were significantly higher in Pflex/LTV group (10.90 ± 9.45) compared to control (6.02 ± 7.95, p = .008).

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Randomized trial evaluates a high PEEP, low tidal volume strategy in ARDS, suggesting improved outcomes.

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Villar et al. (2006) studied this question.

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