Effect Of A Lower Vs Higher PEEP Strategy On Ventilator-Free Days In ICU Patients Without ARDS

Researchers performed this noninferiority randomized clinical trial to ascertain if a ventilation strategy with lower positive end-expiratory pressure (PEEP) is noninferior to a strategy using higher PEEP regarding the number of ventilator-free days at day 28 among patients in the intensive care unit (ICU) who received invasive ventilation for causes other than acute respiratory distress syndrome (ARDS). The study was completed by 969 (99%) of 980 patients who were randomized. In patients in the lower and higher PEEP groups, the occurrence of severe hypoxemia was estimated to be 20.6% vs 17.6% and requirement for rescue strategy was reported to be 19.7% vs 14.6%, respectively. At 28 days, the estimated mortality was 38.4% in the lower PEEP group and 42.0% in the higher PEEP group. Overall, findings demonstrated the noninferiority of a lower PEEP strategy to a higher PEEP strategy in terms of the number of ventilator-free days at day 28 in this study population of patients in the ICU without ARDS who were expected not to be extubated within 24 hours. The use of lower PEEP in patients without ARDS is thus supported.

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