Trial reportCritical care (London, England)2022
Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure: a physiological trial.
Trial report in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 53 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Lung and Diaphragm-Protective Ventilation by Means of Assessing Respiratory Work
Monitoring of Breathing Effort Through Pressure Time Product Measurement Using Airway Occlusion Pressure
Proportional Assist Ventilation Plus and Estimation of Respiratory Effort in Critically Ill Patients During the Transition to Spontaneous Ventilation: A Prospective Cohort Study
Who cites it
53 citing papers in PubMed, 1 synthesis or guideline pooled it, 116 citations in OpenAlex.
- Physiological effects of noninvasive respiratory support strategies in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis.Critical care (London, England) · 2025Pooled it
- Dexmedetomidine for sedation during noninvasive ventilation in COVID-19 patients from the Helmet-COVID randomized clinical trial post-hoc analysis.Scientific reports · 2026Trial
- Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial.Intensive care medicine · 2024Trial
- The impact of a lung-protective ventilation mode using transpulmonary driving pressure titrated positive end-expiratory pressure on the prognosis of patients with acute respiratory distress syndrome.Journal of clinical monitoring and computing · 2024Trial
- Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial.Intensive care medicine · 2024Trial
- Volatile anesthetic sedation in acute respiratory distress syndrome.Intensive care medicine · 2026Review
- ARDS management beyond the guidelines: a practical physiology-based approach to individualized care.Intensive care medicine · 2026Review
- Lung- and diaphragm-protective mechanical ventilation in acute respiratory distress syndrome.Intensive care medicine · 2026Review
- "Ventilator-induced diaphragmatic dysfunction: pathophysiology, monitoring and advances in potential treatment and prevention." W. Fu, L. Guan, Q. LiuEuropean respiratory review : an official journal of the European Respiratory Society · 2026Article
- Association of intraoperative end-tidal CO₂ levels with postoperative pulmonary complications in thoracoscopic lobectomy: a retrospective cohort study.BMC anesthesiology · 2026Observational
- The contribution of mechanical ventilation to critical illness-associated diaphragm dysfunction: a critical appraisal.Critical care (London, England) · 2026Review
- Protective Ventilation During Controlled and Partial Ventilatory Support in ARDS: Clinical-Physiological Background and Monitoring.Journal of clinical medicine · 2026Review
- Diaphragm physiological similarity index (DPSI): a de Novo speckle-tracking ultrasound metric for HFNC adjustment in acute respiratory failure.Critical care (London, England) · 2026Article
- Patient Self-Inflicted Lung Injury in ARDS: From Physiological Concept to Clinical Syndrome.Journal of clinical medicine · 2026Review
- Physiology-guided personalized mechanical ventilation to prevent ventilator-induced lung injury.Frontiers in medicine · 2026Review
- Methods to monitor respiratory effort during mechanical ventilation.Critical care science · 2026Article
- Foundational principles for young intensivists to drive better outcomes: the bedside application of physiology.Critical care science · 2026Article
- Extracorporeal membrane oxygenation with single-site dual-lumen in a patient with SARS-CoV-2-associated acute respiratory distress syndrome: a case report.Frontiers in medicine · 2026Article
- Beyond blood gases: diaphragm-guided sequential non-invasive ventilation for COPD with type II respiratory failure.Frontiers in medicine · 2026Review
- Short-term outcomes across sedation practice patterns in mechanically ventilated patients with bacterial pneumonia: a nationwide cohort study.Annals of intensive care · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInsufficient or excessive respiratory effort during acute hypoxemic respiratory failure (AHRF) increases the risk of lung and diaphragm injury. We sought to establish whether respiratory effort can be optimized to achieve lung- and diaphragm-protective (LDP) targets (esophageal pressure swing - 3 to - 8 cm H
methodsIn patients with early AHRF, spontaneous breathing was initiated as soon as passive ventilation was not deemed mandatory. Inspiratory pressure, sedation, positive end-expiratory pressure (PEEP), and sweep gas flow (in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO)) were systematically titrated to achieve LDP targets. Additionally, partial neuromuscular blockade (pNMBA) was administered in patients with refractory excessive respiratory effort.
resultsOf 30 patients enrolled, most had severe AHRF; 16 required VV-ECMO. Respiratory effort was absent in all at enrolment. After initiating spontaneous breathing, most exhibited high respiratory effort and only 6/30 met LDP targets. After titrating ventilation, sedation, and sweep gas flow, LDP targets were achieved in 20/30. LDP targets were more likely to be achieved in patients on VV-ECMO (median OR 10, 95% CrI 2, 81) and at the PEEP level associated with improved dynamic compliance (median OR 33, 95% CrI 5, 898). Administration of pNMBA to patients with refractory excessive effort was well-tolerated and effectively achieved LDP targets.
conclusionRespiratory effort is frequently absent under deep sedation but becomes excessive when spontaneous breathing is permitted in patients with moderate or severe AHRF. Systematically titrating ventilation and sedation can optimize respiratory effort for lung and diaphragm protection in most patients. VV-ECMO can greatly facilitate the delivery of a LDP strategy.
trial registrationThis trial was registered in Clinicaltrials.gov in August 2018 (NCT03612583).
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.