Transpulmonary pressure guided mechanical ventilation strategy: Tidal volume is adjusted to achieve a target tidal volume of 6 mL/kg predicted body weight (PBW) while controlling end-inspiratory transpulmonary pressure ≤ 20 cmH₂O. PEEP is adjusted to maintain end-expiratory transpulmonary pressure between 0 and 2 cmH₂O.
In control group, PEEP was titrated using the low PEEP:FiO₂ table method.
Study summary
To verify whether the transpulmonary pressure-guided mechanical ventilation strategy can reduce right ventricular involvement, especially the incidence of acute cor pulmonale (ACP), in patients with moderate to severe ARDS induced by pneumonia compared with the currently widely used right ventricular protective mechanical ventilation strategy.
Eligibility
Sex
ALL
Min age
18 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
1. Age ≥ 18 years old
2. ARDS caused by pneumonia (New Global Definition of ARDS)
3. PaO2/FiO2≤200mmHg
4. Received invasive mechanical ventilation
5. Sign the informed consent form
Exclusion Criteria:
1. Invasive mechanical ventilation duration \> 48 hours
2. History of pulmonary hypertension caused by various reasons
3. Severe arrhythmia
4. BMI\>30kg/m2
5. Contraindications to inserting an esophageal catheter (including recent esophageal injury or surgery, severe coagulopathy (platelets \< 5×10⁹/L or INR \> 4)
6. Pregnant and lactating women
7. Lung transplant recipient
8. High-risk factors for increased intracranial pressure (including intracranial hemorrhage, cerebral contusion, cerebral edema, intracranial space-occupying lesions, etc.)
9. Active air leakage in the lungs (pneumothorax, mediastinal emphysema, bronchopleural fistula, air leakage from closed thoracic drainage tubes, etc.)
10. Neuromuscular disease
11. Already received salvage measures (iNO, ECMO, prone position, high-frequency oscillatory ventilation)
12. Severe liver failure
13. Participated in other ARDS-related studies within 30 days
Primary outcome measure(s)
Incidence of right ventricular involvement within 28 days — 28 days Right ventricular involvement is defined as the presence of one of the following findings on transthoracic echocardiography:
ACP: Right ventricular enlargement (RVED/LVED \> 0.6) with paradoxical septal motion; RVF: Right ventricular enlargement (RVED/LVED \> 0.6) accompanied by systemic venous congestion (CVP ≥ 8 mmHg), or if CVP is unavailable, inferior vena cava plethora; RVD: RV FAC \< 35%, or TAPSE ≤ 16 mm.
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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