Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial.

Summary

This international, investigator-initiated RCT will test a physiology-guided individualized ventilation strategy against conventional PEEP-FiO2 tables in moderate-to-severe ARDS, with 60-day all-cause mortality as the primary endpoint. The design includes assessment of lung recruitability and airway opening pressure, control of distending pressure, and respiratory drive, across COVID-19 and non-COVID-19 ARDS subgroups.

Key Findings

• Multicentre, open-label RCT (33 centres, 8 countries) plans to enroll 740 patients with moderate-to-severe ARDS.
• Intervention arm individualizes PEEP via one-breath derecruitment and airway opening pressure, and controls distending pressure and respiratory drive.
• Two ARDS subpopulations (COVID-19-induced and non-COVID-19) will be analyzed with 60-day all-cause mortality as the primary outcome.

Clinical Implications

While results are pending, the protocol highlights practical methods (one-breath derecruitment, airway opening pressure) that can be piloted in physiologically focused ARDS management and inform protocolized care.

Limitations

• Open-label design may introduce performance bias.
• As a protocol paper, no efficacy results are yet available; implementation complexity may vary across centres.

Future Directions

Completion of the trial and subgroup analyses will clarify which patients benefit most; integration with diaphragm-protective strategies and automated monitoring could be explored.