Respiratory failure & ventilation
Driving pressure-limited ventilation strategies versus conventional lung protective ventilation strategies for patients with ARDS/ARF: a systematic review and meta-analysis of randomized controlled trials
Authors' conclusion
Based on current limited evidence, DP-limited ventilation showed no clear benefit over CLPV in patients with ARDS/ARF, with no survival benefit and a shorter length of ICU stay
Study context
- Population
- Patients with ARDS/acute respiratory failure (ARF)
- Participants
- 465 patients · 4 randomized controlled trials (RCTs)
- Comparison
- Driving pressure (DP)-limited ventilation vs CLPV
- Outcome
- Short-term mortality
Pooled result
As reported in the abstract
28-day mortality · 28 days
- No significant difference between the groups in 28-day mortality (4 RCTs, 465 patients): OR 1.01, 95% CI 0.49, 2.10, P = 0.98, I2 = 56%
- I2 = 56%
Further pooled results
| Outcome | Mean difference (days) (95% CI) | P value | |
|---|---|---|---|
| ICU LOS4 RCTs, 465 patients; I2 = 7% | −2.95 ([−5.17, −0.74]) | P = 0.009 | |
| −10−505Difference, days (linear scale) |
Intensive care unit (ICU) mortality
- No significant difference between the groups in ICU mortality (3 RCTs, 355 patients): OR 1.24, 95% CI 0.81, 1.89, P = 0.33, I2 = 36%
In-hospital mortality
- No significant difference between the groups in in-hospital mortality (3 RCTs, 355 patients): OR 1.21, 95% CI 0.79, 1.84, P = 0.38, I2 = 0%
Ventilator-free days within 28 days
- No difference between the two ventilation strategies
- P = 0.86
Hospital LOS
- No difference between the two ventilation strategies
- P = 0.52
Safety
Barotrauma
- No significant difference in incidence
- P = 0.31
Acidosis
- No significant difference in incidence
- P = 0.43
Original publication
Driving pressure-limited ventilation strategies versus conventional lung protective ventilation strategies for patients with ARDS/ARF: a systematic review and meta-analysis of randomized controlled trials. Crit Care. Published 4 December 2025. doi:10.
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