Individualized Lung-Protective Ventilation Strategy Based on Esophageal Pressure Monitoring in Patients With ARDS Associated With Severe Acute Pancreatitis-A Randomized Controlled Trial.

Summary

In a single-center RCT of 124 SAP-related ARDS patients, esophageal pressure–guided individualized ventilation decreased transpulmonary and driving pressures, improved compliance and oxygenation, and shortened ventilation duration and ICU stay. EPM guidance also reduced VAP incidence and 28-day mortality (19.35% vs 32.26%), and ΔPL at 72 h independently predicted 28-day mortality (AUC 0.832).

Key Findings

• EPM-guided ventilation lowered PL, ΔPL, and ΔP compared with conventional strategy.
• Static compliance and PaO2/FiO2 were significantly higher in the EPM-guided group.
• Mechanical ventilation duration and ICU length of stay were shorter with EPM guidance.
• VAP incidence and 28-day mortality were reduced (19.35% vs 32.26%; p=0.042).
• ΔPL at 72 h independently predicted 28-day mortality (OR 1.56; AUC 0.832).

Clinical Implications

Consider integrating Pes monitoring to tailor PEEP and minimize ΔPL/ΔP in SAP-related (and potentially broader) ARDS, and use 72-h ΔPL for risk stratification. Multicenter replication is needed before guideline adoption.

Limitations

• Single-center trial with modest sample size
• Potential lack of blinding and absence of long-term outcomes

Future Directions

Conduct multicenter RCTs to validate EPM-guided protocols, define target ΔPL/PL thresholds, and assess cost-effectiveness and generalizability to non-SAP ARDS.