Positive-end expiratory pressure titration and transpulmonary pressure: the EPVENT 2 trial
Open accessAbstract
The acute respiratory distress syndrome (ARDS) is an acute inflammatory lung edema. The current definition includes three severity stages based on PaO 2 /FiO 2 ratio measured at positive end-expiratory pressure (PEEP) of 5 cmH 2 O or more (1). ARDS was described for the first time by Ashbaugh et al . in 1967; it was suggested that PEEP could have beneficial effects (2). More than 50 years after its initial description ARDS is still of great concern for the intensivist because it accounts for 10% of ICU admissions and still supports a rough 40% mortality rate (3). Furthermore, ARDS can only be treated in the ICU environment because it very often requires invasive mechanical ventilation and because the mechanical ventilation settings can impact patient outcome.
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While the pilot study suggested benefit, the subsequent 200 patient multicentre RCT that compared PEEP titration guided by esophageal (PES) measurement versus empirical high PEEP-FiO2 titration, showed no significant difference in a composite outcome of death and days free from mechanical ventilation through day 28.
“While the pilot study suggested benefit [448], the subsequent 200 patient multicentre RCT that compared PEEP titration guided by esophageal (PES) measurement versus empirical high PEEP-FiO2 titration, showed no significant difference in a composite outcome of death and days free from mechanical ventilation through day 28 [449].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [449]
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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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- Authors
- Turbil, E., Galerneau, L. M., Terzi, N., Schwebel, C., Argaud, L., & Guérin, C.
- Affiliations
- University of Sassari (IT)
- Centre Hospitalier Universitaire de Grenoble (FR)
- Université de Lyon (FR)
- Inserm (FR)
- Corresponding author
- Guérin, Claude
- Venue
- Journal of Thoracic Disease
- Publisher
- AME Publishing Company
- Published
- 2019-09
- Volume
- 11
- Issue
- S15
- Pages
- S2012-S2017
- ISSN
- 2072-1439 (ISSN-L)
- 2077-6624
- PMC
- PMC6783739
- OpenAlex
- W2949691256
- Cited by
- 8
- References
- 29
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2018: 1
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Thoracic Disease (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- 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 › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- positive end-expiratory pressure, PEEP titration, transpulmonary pressure, mechanical ventilation, acute respiratory distress syndrome
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