• Br J Anaesth · Nov 2024

    Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia: the STAMINA randomised clinical trial.

    • Israel Silva Maia, Alexandre Biasi Cavalcanti, Lucas Tramujas, Viviane Cordeiro Veiga, Júlia Souza Oliveira, Erica Regina Ribeiro Sady, Letícia Galvão Barbante, Marina Lazzari Nicola, Rodrigo Magalhães Gurgel, Lucas Petri Damiani, Karina Leal Negrelli, Tamiris Abait Miranda, Ligia Nasi Laranjeira, Bruno Tomazzini, Cassio Zandonai, Mariangela Pimentel Pincelli, Glauco Adrieno Westphal, Ruthy Perotto Fernandes, Rodrigo Figueiredo, Cíntia Loss Sartori Bustamante, Luiz Fernando Norbin, Emerson Boschi, Rafael Lessa, Marcelo Pereira Romano, Mieko Cláudia Miura, Soares de Alencar FilhoMetonMHospital São Vicente de Paulo, Barbalha, Brazil., Cés de Souza DantasVicenteVHospital Marcílio Dias, Rio de Janeiro, Brazil., Priscilla Alves Barreto, Mauro Esteves Hernandes, Cintia Grion, Alexandre Sanches Laranjeira, Ana Luiza Mezzaroba, Marina Bahl, Ana Carolina Starke, Rodrigo Biondi, Felipe Dal-Pizzol, Eliana Caser, Marlus Muri Thompson, Andrea Allegrini Padial, Rodrigo Thot Leite, Gustavo Araújo, Mário Guimarães, Priscilla Aquino, Fábio Lacerda, Hoffmann FilhoConrado RobertoCRHospital Regional Hans Dieter Schmidt, Joinville, Brazil., Livia Melro, Eduardo Pacheco, Gustavo Ospina-Táscon, Juliana Carvalho Ferreira, Fabricio Jocundo Calado Freires, Flávia Ribeiro Machado, Fernando Godinho Zampieri, and BRICNet.
    • Instituto de Pesquisa Hcor, São Paulo, Brazil; Divisão de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Nereu Ramos, Florianópolis, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil.
    • Br J Anaesth. 2024 Nov 25.

    BackgroundThis study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS).MethodsThis is a multi-centre, randomised trial, enrolling adults with moderate to severe ARDS secondary to community-acquired pneumonia. Patients were randomised to a driving pressure-limiting strategy or low PEEP strategy based on a PEEP:FiO2 table. All patients received volume assist-control mode until day 3 or when considered ready for spontaneous modes of ventilation. The primary outcome was ventilator-free days within 28 days. Secondary outcomes were in-hospital and intensive care unit mortality at 90 days.ResultsThe trial was stopped because of recruitment fatigue after 214 patients were randomised. In total, 198 patients (n=96 intervention group, n=102 control group) were available for analysis (median age 63 yr, [interquartile range 47-73 yr]; 36% were women). The mean difference in driving pressure up to day 3 between the intervention and control groups was -0.7 cm H2O (95% confidence interval -1.4 to -0.1 cm H2O). Mean ventilator-free days were 6 (sd 9) in the driving pressure-limiting strategy group and 7 (9) in the control group (proportional odds ratio 0.72, 95% confidence interval 0.39-1.32; P=0.28). There were no significant differences regarding secondary outcomes.ConclusionsIn patients with moderate to severe ARDS secondary to community-acquired pneumonia, a driving pressure-limiting strategy did not increase the number of ventilator-free days compared with a standard low PEEP strategy within 28 days.Clinical Trial RegistrationNCT04972318.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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