Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study

Abstract

Background: Secondary analyses of randomized controlled trials found that driving pressure (DP) ≤ 14 cm H2O may be associated with improved clinical outcomes in acute respiratory distress syndrome (ARDS) patients. Therefore, the aim of this study was to evaluate the effect of DP-guided ventilation compared to conventional protective lung ventilation (PLV) on clinical outcomes in ARDS patients. Methods: In this prospective, controlled trial, 110 patients with ARDS were randomly assigned according to ventilatory strategy into conventional PLV group and DP-guided ventilation group (by maintaining DP value ≤ 14 cm H2O). Clinical outcomes were incidence of mortality at 28th day (primary outcome), PaO2/FiO2, static compliance (Cstat), organ(s) dysfunction, mechanical ventilation (MV) duration, and length of ICU stay. Results: Incidence of mortality at 28th day was reduced in DP-guided ventilation group compared to PLV group (20% vs. 5.45%); the hazard ratio was 0.26)95% CI: 0.09 to 0.73). The PaO2/FiO2, C stat and MV-free days were higher in in DP-guided ventilation group compared to PLV group. Organ dysfunction, duration of MV and length of ICU stay were significantly lower DP-guided ventilation group compared to PLV group. Conclusions: In patients with ARDS, DP-guided ventilation showed improved survival, Cstat and oxygenation and lower incidence of organ dysfunction, duration of MV and length of ICU stay compared to PLV.