The Effect of Transpulmonary Pressure-Guided Positive End-Expiratory Pressure Titration on Pulmonary Arterial Compliance in Acute Respiratory Distress Syndrome Patients: A Single-Center, Randomized Controlled Pilot Pathophysiological Study
Xiao Tang, Ting Li, Hua Yang, Ya-Lan Liu, Wen-Rui Lyu, Yu Zhao, Hai-Chao Li, Meng Li, Hu Li, Yu Jin, Xu-Yan Li, Zhao-Hui Tong, Bing SunOBJECTIVES:
To compare the function of positive end-expiratory pressure (PEEP) titration guided by transpulmonary pressure (Ptp) with traditional lung-protective ventilation to optimize pulmonary arterial compliance (Cpa) in acute respiratory distress syndrome (ARDS) patients.
DESIGN:
A single center, randomized controlled pilot pathophysiological study.
SETTING:
A respiratory ICU in China.
PATIENTS/SUBJECTS:
Adult patients diagnosed with ARDS who had received invasive mechanical ventilation for less than 72 hours.
INTERVENTIONS:
Patients were randomized to the Ptp group or empirical low tidal volume lung-protective group.
MEASUREMENTS AND MAIN RESULTS:
The primary endpoint was the difference in the Cpa dynamic changes between the two groups during the first 72 hours of intervention following enrollment. A total of 40 patients were included in the study, with 20 patients in the Ptp group and 20 patients in the control group. The Cpa in the Ptp group was 3.98 ± 0.46 mL/mm Hg at randomization, which was not significantly different from that in the control group (3.89 ± 0.40 mL/mm Hg). The Cpa in the Ptp group was significantly higher than that in the control group (
CONCLUSIONS:
Ptp-guided PEEP titration was superior to traditional lung-protective ventilation in maintaining a higher Cpa and preserving right ventricular function in patients with moderate-to-severe ARDS caused by pneumonia.