Compliance-guided versus FiO 2 -driven positive-end expiratory pressure in patients with moderate or severe acute respiratory distress syndrome according to the Berlin definition.

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 FiO2 upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS).

SETTING: A Spanish medical-surgical ICU.

DESIGN: A post hoc analysis of a randomized controlled pilot study.

PATIENTS: Patients with ARDS.

INTERVENTIONS: Ventilation with low tidal volumes and pressure limitation at 30cmH2 O, randomized in two groups according to the method used to set PEEP: FiO2 -guided PEEP group according to FiO2 applied and compliance-guided group according to the highest compliance.

PRIMARY VARIABLES OF INTEREST: 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.