Respiratory failure & ventilation
Comparison of two transpulmonary pressure-based positive end-expiratory pressure titration strategies in acute respiratory distress syndrome: a randomized crossover study
Authors' conclusion
The two transpulmonary pressure-based titration strategies result in different PEEP levels in most patients. Neither strategy is associated with higher recruited lung volume or lower estimated Stress and Strain.
Study context
- Population
- Patients with moderate to severe acute respiratory distress syndrome (ARDS) (PaO2/FiO2 < 150 mmHg) in an academic ICU
- Participants
- 20 patients
- Comparison
- PL,exp-based vs PL,insp-based positive end-expiratory pressure (PEEP) titration
- Primary endpoint
- PEEP levels obtained with the two strategies and their physiological effects
- Follow-up
- End of each 45-min PEEP application period
Methodological detailssingle-centre, Each strategy applied for 45 min in randomised order, separated by a 45-min washout
- Single-centre
- Each strategy applied for 45 min in randomised order, separated by a 45-min washout
Primary result
As reported in the abstract
PEEP level
Difference of at least 3 cmH2O in PEEP
14 (70%) patients
Further findings
PEEP level in non-obese and obese patients (subgroup)
- PL, insp strategy gave higher PEEP than PL, exp strategy in non-obese but not obese patients
Gas exchange, hemodynamics and respiratory mechanics
- Did not differ between strategies, overall or in obese and non-obese patients separately
Recruited lung volume from PEEP 5 cmH2O, PL,insp, transpulmonary driving pressure, lung strain
- Did not differ between the two strategies
Original publication
Comparison of two transpulmonary pressure-based positive end-expiratory pressure titration strategies in acute respiratory distress syndrome: a randomized crossover study. Crit Care. Published 29 September 2025. doi:10.
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