Driving pressure-limited ventilation strategies versus conventional lung protective ventilation strategies for patients with ARDS/ARF: a systematic review and meta-analysis of randomized controlled trials.
Summary
This RCT-only meta-analysis found no short-term survival advantage of driving pressure–limited ventilation over conventional lung-protective ventilation in ARDS/ARF, though ICU length of stay was shorter. Findings support continued use of conventional strategies while awaiting larger trials to define DP-limiting’s role and phenotypes that may benefit.
Key Findings
- Meta-analysis of 4 RCTs found no short-term mortality benefit of DP-limited ventilation versus conventional lung-protective ventilation in ARDS/ARF.
- ICU length of stay was shorter with DP-limited strategies despite no survival advantage.
- Study was pre-registered (PROSPERO CRD420251069853), supporting methodological transparency.
Clinical Implications
Maintain conventional lung-protective ventilation (low tidal volume, appropriate PEEP) rather than adopting DP-limited protocols as standard; consider DP as a monitoring/optimization target but not as a standalone treatment strategy pending further evidence.
Why It Matters
It directly addresses a widely discussed surrogate (driving pressure) with RCT evidence synthesis, clarifying that targeting DP has not yet translated into survival benefit.
Limitations
- Only four RCTs with potentially limited power and heterogeneity of implementation protocols
- Incomplete reporting of some secondary outcomes and DP-standardization procedures across trials
Future Directions
Large, pragmatic RCTs to test DP-targeted protocols with standardized measurement, phenotype-enrichment strategies, and patient-centered outcomes.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Meta-analysis of randomized controlled trials assessing mortality and ICU length of stay
- Study Design
- OTHER