title: Compliance-guided versus FiO2-driven positive-end expiratory pressure in patients with moderate or severe acute respiratory distress syndrome according to the Berlin definition.
abstract: OBJECTIVE
  To study the effect of setting positive end-expiratory pressure (PEEP) in an individualized manner (based on highest static compliance) compared to setting PEEP according to FiO2upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  A Spanish medical-surgical ICU.
  
  
  METHODS
  A post hoc analysis of a randomized controlled pilot study.
  
  
  METHODS
  Patients with ARDS.
  
  
  METHODS
  Ventilation with low tidal volumes and pressure limitation at 30cmH2O, randomized in two groups according to the method used to set PEEP: FiO2-guided PEEP group according to FiO2applied and compliance-guided group according to the highest compliance.
  
  
  METHODS
  Demographic data, risk factors and severity of ARDS, APACHE II and SOFA scores, daily Lung Injury Score, ventilatory measurements, ICU and hospital stay, organ failure and mortality at day 28 and 90 after inclusion.
  
  
  RESULTS
  A total of 159 patients with ARDS were evaluated, but just 70 patients were included. Severe ARDS patients showed more organ dysfunction-free days at 28 days (12.83±10.70 versus 3.09±7.23; p=0.04) and at 90 days (6.73±22.31 vs. 54.17±42.14, p=0.03), and a trend toward lower 90-days mortality (33.3% vs. 90.9%, p=0.02), when PEEP was applied according to the best static compliance. Patients with moderate ARDS did not show these effects.
  
  
  CONCLUSIONS
  In patients with severe ARDS, individualized PEEP selection based on the best static compliance was associated to lower mortality at 90 days, with an increase in organ dysfunction-free days at 28 and 90 days.
authors: Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, Madrid 28805, Spain. Electronic address: consuelopintado@yahoo.es.
authors: M-C
authors: MC
authors: Pintado
authors: Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, Madrid 28805, Spain.
authors: R
authors: R
authors: de Pablo
authors: Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, Madrid 28805, Spain.
authors: M
authors: M
authors: Trascasa
authors: Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, Madrid 28805, Spain.
authors: J-M
authors: JM
authors: Milicua
authors: Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, Madrid 28805, Spain.
authors: M
authors: M
authors: Sánchez-García
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010100:Oxygen / Q000032:analysis; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000209:etiology / Q000517:prevention & control
chemical_list: D010100:Oxygen
keywords: Acute respiratory distress syndrome; Complianza estática; Fracaso multiorgánico; Mechanical ventilation; Multiple organ failure; Outcomes; Positive end-expiratory pressure; Presión positiva al final de la espiración; Resultados; Static compliance; Síndrome de distrés respiratorio agudo; Ventilación mecánica