Spontaneous breathing during the transition from controlled to assisted ventilation in ARDS may be harmful, as high respiratory drive can generate large transpulmonary pressure swings and worsen lung injury. Higher PEEP may mitigate this by reducing inspiratory effort and lung stress, but patient response is variable and difficult to predict. While improved lung compliance appears to mediate the protective effects of PEEP, its bedside assessment is complex. Preclinical data suggest that changes in compliance are inversely reflected by changes in respiratory rate, but this relationship and its clinical utility in ARDS patients remain unclear.
Need of invasive mechanical ventilation
Patients who had fulfill ARDS criteria based on Berlin definition during any time of invasive mechanical ventilation.
Patient ventilated in pressure support ventilation.
Time of invasive ventilation expected to be longer than 24 hs after the day of enrollment.
Neuromuscular diseases (e.g., amyotrophic lateral sclerosis, Duchenne Erb)
previous diagnosis of chronic obstructed pulmonary disease
not resolved pneumothorax
bronchopleural fistula