Effect of a Lower Vs. Higher Positive End-Expiratory Pressure Strategy on Clinically Relevant Outcomes in ICU Patients Without Acute Respiratory Distress Syndrome: Bayesian Re-analysis of the REstricted Vs. Liberal Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome (RELAx) Randomized Clinical Trial

doi:10.1097/ccm.0000000000007117

Respiratory failure & ventilation

Effect of a Lower Vs. Higher Positive End-Expiratory Pressure Strategy on Clinically Relevant Outcomes in ICU Patients Without Acute Respiratory Distress Syndrome: Bayesian Re-analysis of the REstricted Vs. Liberal Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome (RELAx) Randomized Clinical Trial

Crit Care MedPublished 31 Mar 2026Post hoc Bayesian re-analysis of the RELAx randomised trial

Primary result · Higher VFD-28ResultOdds ratio 1.08 95% CrI 0.87–1.35

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Authors' conclusion

Although the probability of benefit in the overall population was modest, the analysis suggested a higher probability of benefit in selected subgroups, particularly patients admitted for other reasons than cardiac arrest or intubated for other reasons than respiratory failure.

Study context

Population: Invasively ventilated ICU patients without Acute Respiratory Distress Syndrome (ARDS), expected to require ventilation ≥24 hours; 8 ICUs, October 2017–March 2019
Participants: 980 participants

Comparison: Lower positive end-expiratory pressures (PEEP) vs higher PEEP
Primary endpoint: Ventilator-free days at day 28 (VFD-28)
Follow-up: Day 28

Methodological detailsnon-inferiority, multicentre

Non-inferiority
Multicentre

Primary result

Higher VFD-28

Odds ratio

1.08

95% CrI 0.87–1.35

Lower PEEP vs Higher PEEP

OR 1.08 (95% CrI 0.87–1.35)

As reported in the abstract

Probability of superiority of lower PEEP: 75% to 78%

Secondary outcomes

28-day mortality

Probability of benefit of lower PEEP: 72% to 89%

Duration of ventilation

Probability of benefit of lower PEEP: 11% to 28%

Subgroups: admitted for reasons other than cardiac arrest or intubated for reasons other than respiratory failure (subgroup)

Probabilities of benefit with lower PEEP exceeded 90%

Original publication

Effect of a Lower Vs. Higher Positive End-Expiratory Pressure Strategy on Clinically Relevant Outcomes in ICU Patients Without Acute Respiratory Distress Syndrome: Bayesian Re-analysis of the REstricted Vs. Liberal Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome (RELAx) Randomized Clinical Trial. Crit Care Med. Published 31 March 2026. doi:10.1097/ccm.0000000000007117

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