Study of Two Personalized Positive End-Expiratory Pressure PEEP Strategies after Lung Recruitment in Adults with Moderate to Severe Acute Respiratory Distress Syndrome ARDS

What this Trial Is About

Acute Respiratory Distress Syndrome ARDS causes severe low oxygen levels and widespread lung collapse, often requiring mechanical ventilation. This study evaluates two personalized strategies for setting positive end-expiratory pressure PEEP during ventilation in adults with moderate-to-severe ARDS within 36 hours of diagnosis. It investigates how lung recruitment potential, measured by the recruitment-to-inflation ratio, influences early responses to these PEEP settings. Both groups start with the same lung recruitment maneuver to standardize lung conditions before treatment. Participants are randomly assigned to one of two PEEP titration methods after the initial lung recruitment maneuver. One group receives PEEP adjusted to achieve the best static respiratory compliance, while the other groups PEEP is guided by transpulmonary pressure measured with an esophageal balloon to maintain positive pressure at end expiration. The maneuver involves increasing PEEP stepwise under pressure-controlled ventilation, with strict limits on airway pressure for one minute. Protective ventilation settings are maintained throughout the study. Participants will be monitored with physiological measurements including oxygenation, respiratory pressures, ventilatory efficiency, and lung compliance at baseline, 1, 24, 48, and 72 hours after intervention. The primary outcome is the change in oxygenation PaO2FiO2 ratio at 24 hours. Safety is tracked through adverse events during ventilation up to 28 days, and ventilator-free days are recorded. The study lasts until completion in 2027, with data collected to understand how lung recruitability affects early mechanical and gas exchange outcomes.

Influence of Lung Recruitment Potential on Positive End-Expiratory Pressure (PEEP) Titration Strategies in Acute Respiratory Distress Syndrome (ARDS) Patients.