LAUSR

Purpose: Pulmonary recruitment and positive end‐expiratory pressure (PEEP) titrated according to minimal static elastance of the respiratory system (PEEPEstat,RS) compared to PEEP set according to the ARDSNetwork table (PEEPARDSNetwork) as a strategy to prevent ventilator‐associated lung injury (VALI) in patients with acute respiratory distress syndrome (ARDS) increases mortality. Alternatively, avoiding negative end‐expiratory transpulmonary pressure has been discussed as superior PEEP titration strategy. Therefore, we tested whether PEEPEstat,RS or PEEPARDSNetwork prevent negative end‐expiratory transpulmonary pressure in ARDS patients. Material and methods: Thirteen patients with moderate to severe ARDS were studied at PEEPARDSNetwork versus PEEPEstat,RS. Patients were then grouped post hoc according to the end‐expiratory transpulmonary pressure (positive or negative). Results: 7 out of 13 patients showed negative end‐expiratory transpulmonary pressures (Ptp−) with both strategies (PEEPARDSNetwork: ‐ 5.4 ± 3.5 vs. 2.2 ± 3.7 cm H2O, p = .005; PEEPEstat,RS: ‐ 3.6 ± 1.5 vs. 3.5 ± 3.3 cm H2O, p < .001). Ptp− was associated with higher intra‐abdominal pressure and lower end‐expiratory lung volume with both PEEP strategies. Conclusions: In patients with moderate‐to‐severe ARDS, PEEP titrated according to the minimal static elastance of the respiratory system or according to the ARDSNetwork table did not prevent negative end‐expiratory transpulmonary pressure.