Effect of Titrating PEEP with Esophageal Pressure-Guided Strategy vs Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With ARDS

jamanetwork.com March 6, 2019

Among patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS), PES-guided positive end-expiratory pressure (PEEP), compared with empirical high PEEP-Fio2, resulted in no significant difference in death and days free from mechanical ventilation. These findings do not support PES-guided PEEP titration in ARDS. 200 patients were enrolled and completed 28-day follow-up. The primary composite end point was not significantly different between treatment groups. At 28 days, 33 of 102 patients assigned to PES-guided PEEP and 30 of 98 patients assigned to empirical PEEP-Fio2 died. The primary outcome was a ranked composite score incorporating death and days free from mechanical ventilation among survivors through day 28. Prespecified secondary outcomes included 28-day mortality, days free from mechanical ventilation among survivors, and need for rescue therapy.