ArticleBMJ open respiratory research2024
Comparing the impact of targeting limited driving pressure to low tidal volume ventilation on mortality in mechanically ventilated adults with COVID-19 ARDS: an exploratory target trial emulation.
Article in BMJ open respiratory research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Driving pressure-limited ventilation strategies versus conventional lung protective ventilation strategies for patients with ARDS/ARF: a systematic review and meta-analysis of randomized controlled trials.Critical care (London, England) · 2025Pooled it
- Effects of extracorporeal carbon dioxide removal in facilitating ultra-protective ventilation strategies for patients with acute respiratory distress syndrome: a systematic review and meta-analysis.Frontiers in medicine · 2025Pooled it
- Stress hyperglycemia ratio improves machine learning-based mortality risk prediction in critically ill COVID-19 patients: a multicenter retrospective study.BMC infectious diseases · 2026Article
- Causal estimation of time-varying treatments in observational studies: a scoping review of methods, applications, and missing data practices.BMC medical research methodology · 2025Article
- SARS-CoV-2 Pneumonia: Advances in Diagnosis and Treatment.Microorganisms · 2025Review
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Authors and funding
6 authors.
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Abstract
backgroundAn association between driving pressure (∆P) and the outcomes of invasive mechanical ventilation (IMV) may exist. However, the effect of a sustained limitation of ∆P on mortality in patients with acute respiratory distress syndrome (ARDS), including patients with COVID-19 (COVID-19-related acute respiratory distress syndrome (C-ARDS)) undergoing IMV, has not been rigorously evaluated. The use of emulations of a target trial in intensive care unit research remains in its infancy. To inform future, large ARDS target trials, we explored using a target trial emulation approach to analyse data from a cohort of IMV adults with C-ARDS to determine whether maintaining daily ∆p<15 cm H
methodsTo emulate a target trial, adults with C-ARDS requiring >24 hours of IMV were considered to be assigned to limited ∆P or LTVV. Lung mechanics were measured twice daily after ventilator setting adjustments were made. To evaluate the effect of each lung-protective ventilation (LPV) strategy on the 28-day mortality, we fit a stabilised inverse probability weighted marginal structural model that adjusted for baseline and time-varying confounders known to affect protection strategy use/adherence or survival.
resultsAmong the 92 patients included, 27 (29.3%) followed limited ∆P ventilation, 23 (25.0%) the LTVV strategy and 42 (45.7%) received no LPV strategy. The adjusted estimated 28-day survival was 47.0% (95% CI 23%, 76%) in the limited ∆P group, 70.3% in the LTVV group (95% CI 37.6%, 100%) and 37.6% (95% CI 20.8%, 58.0%) in the no LPV strategy group.
interpretationLimiting ∆P may not provide additional survival benefits for patients with C-ARDS over LTVV. Our results help inform the development of future target trial emulations focused on evaluating LPV strategies, including reduced ∆P, in adults with ARDS.
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