The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.
Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure–Guided Strategy vs an Empirical High PEEP-F io 2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial
Open accessAbstract
Importance: Adjusting positive end-expiratory pressure (PEEP) to offset pleural pressure might attenuate lung injury and improve patient outcomes in acute respiratory distress syndrome (ARDS). Objective: To determine whether PEEP titration guided by esophageal pressure (PES), an estimate of pleural pressure, was more effective than empirical high PEEP-fraction of inspired oxygen (Fio2) in moderate to severe ARDS. Design, Setting, and Participants: Phase 2 randomized clinical trial conducted at 14 hospitals in North America. Two hundred mechanically ventilated patients aged 16 years and older with moderate to severe ARDS (Pao2:Fio2 ≤200 mm Hg) were enrolled between October 31, 2012, and September 14, 2017; long-term follow-up was completed July 30, 2018. Interventions: Participants were randomized to PES-guided PEEP (n = 102) or empirical high PEEP-Fio2 (n = 98). All participants received low tidal volumes. Main Outcomes and Measures: The primary outcome was a ranked composite score incorporating death and days free from mechanical ventilation among survivors through day 28. Prespecified secondary outcomes included 28-day mortality, days free from mechanical ventilation among survivors, and need for rescue therapy. Results: Two hundred patients were enrolled (mean [SD] age, 56 [16] years; 46% female) and completed 28-day follow-up. The primary composite end point was not significantly different between treatment groups (probability of more favorable outcome with PES-guided PEEP: 49.6% [95% CI, 41.7% to 57.5%]; P = .92). At 28 days, 33 of 102 patients (32.4%) assigned to PES-guided PEEP and 30 of 98 patients (30.6%) assigned to empirical PEEP-Fio2 died (risk difference, 1.7% [95% CI, -11.1% to 14.6%]; P = .88). Days free from mechanical ventilation among survivors was not significantly different (median [interquartile range]: 22 [15-24] vs 21 [16.5-24] days; median difference, 0 [95% CI, -1 to 2] days; P = .85). Patients assigned to PES-guided PEEP were significantly less likely to receive rescue therapy (4/102 [3.9%] vs 12/98 [12.2%]; risk difference, -8.3% [95% CI, -15.8% to -0.8%]; P = .04). None of the 7 other prespecified secondary clinical end points were significantly different. Adverse events included gross barotrauma, which occurred in 6 patients with PES-guided PEEP and 5 patients with empirical PEEP-Fio2. Conclusions and Relevance: Among patients with moderate to severe ARDS, PES-guided PEEP, compared with empirical high PEEP-Fio2, resulted in no significant difference in death and days free from mechanical ventilation. These findings do not support PES-guided PEEP titration in ARDS. Trial Registration: ClinicalTrials.gov Identifier NCT01681225.
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“Esophageal pressure guided PEEP titration has been evaluated in two trials [447, 448].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [447]
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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935
Acute respiratory distress syndrome
Matthay, M. A., Zemans, R. L., Zimmerman, G. A., Arabi, Y. M., Beitler, J. R., Mercat, A., Herridge, M. S., Randolph, A. G., & Calfee, C. S. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0069-0 · Cited by 2,514
Self-citationAcute respiratory distress syndrome
Meyer, N. J., Gattinoni, L., & Calfee, C. S. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00439-6 · Cited by 1,242
Grasselli, G., Calfee, C. S., Camporota, L., Poole, D., Amato, M. B. P., Antonelli, M. M., Arabi, Y. M., Baroncelli, F., Beitler, J. R., Bellani, G., et al. (2023) · Intensive Care Medicine · doi:10.1007/s00134-023-07050-7 · Cited by 1,035
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Metadata
- Authors
- Beitler, J. R., Sarge, T., Banner-Goodspeed, V. M., Gong, M. N., Cook, D., Novack, V., Loring, S. H., Talmor, D., & for the EPVent-2 Study Group
- Affiliations
- Columbia University (US)
- Beth Israel Deaconess Medical Center (US)
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Albert Einstein College of Medicine (US)
- McMaster University (CA)
- Soroka Medical Center (IL)
- Corresponding author
- Talmor, Daniel
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-05
- Volume
- 321
- Issue
- 9
- Pages
- 846
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6439595
- OpenAlex
- W2912354430
- Cited by
- 469
- References
- 43
- Citations by year
- 2026: 49 · 2025: 53 · 2024: 64 · 2023: 61 · 2022: 65 · 2021: 80 · 2020: 52 · 2019: 45
- FWCI
- 44.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (UM1HL108724, K23HL133489, L30 HL129438)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- acute respiratory distress syndrome, positive end-expiratory pressure, PEEP titration, esophageal pressure, pleural pressure, mechanical ventilation, low tidal volume, fraction of inspired oxygen, 28-day mortality, weaning from mechanical ventilation, salvage therapy, lung injury, ARDSNet
- MeSH terms
- Adult, Aged, Esophagus, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Pressure, Respiratory Distress Syndrome, Respiratory Physiological Phenomena
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