TY - JOUR T1 - INDIVIDUALIZED POSITIVE END-EXPIRATORY PRESSURE SETTING IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME. A RANDOMIZED CONTROLLED PILOT STUDY JF - Respiratory Care DO - 10.4187/respcare.02068 SP - respcare.02068 AU - María-Consuelo Pintado AU - Raúl de Pablo AU - María Trascasa AU - José-María Milicua AU - Santiago Rogero AU - Martín Daguerre AU - José-Andrés Cambronero AU - Ignacio Arribas AU - Miguel Sánchez-García Y1 - 2013/01/29 UR - http://rc.rcjournal.com/content/early/2013/01/29/respcare.02068.abstract N2 - Background: Low-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of possitive end-expiratory pressure (PEEP) is intended to keep the alveoli open. No method of adjusting the optimal PEEP level has shown to be superior and improve clinical outcomes. We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at highest compliance on oxygenation, multiple organ disfunction (MOD) and survival in patients with the acute respiratory distress syndrome (ARDS). Methods: Patients with ARDS ventilated with low tidal volumes and limitation of airway pressure at 30 cmH2O were randomized to a compliance-guided PEEP level or to an FiO2-driven study group. Results: Out of 159 patients with ARDS admitted during the study period, 70 patients met inclusion criteria for the present study. Patients in the compliance-guided group showed non-significant improvements in PaO2/FiO2 ratio during the first 14 days and 28-day mortality (20.6% vs. 38.9%, p=0.12). MOD-free days (median 6 vs. 20, p=0.02), respiratory failure-free days (median 7 vs. 14, p=0.03) and hemodynamic failure-free days (median 16 vs. 22, p=0.04) at 28 days were significantly lower in patients with compliance-guided setting of PEEP level. Conclusions: In ARDS patients, protective mechanical ventilation with PEEP application according to the highest compliance is associated with less organ dysfunction and a strong non-significant trend toward lower mortality. ER -