SynthesisCritical care (London, England)2025
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.
Synthesis in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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
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Who cites it
3 citing papers in PubMed.
- Comparison of systemic vascular resistance index-guided versus conventional fluid management on airway pressure, oxygenation and postoperative recovery in patients undergoing one-lung ventilation for thoracic surgery.American journal of translational research · 2026Article
- Independent predictors of long-term pulmonary function recovery in patients with acute respiratory distress syndrome: a meta-analysis.American journal of translational research · 2026Review
- Lactylation-driven PDLIM1/PDAP1 axis remodels the inflammatory landscape of acute lung injury: mechanistic insights and precision intervention.Frontiers in immunology · 2026Article
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Authors and funding
3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough driving pressure (DP) has been consistently demonstrated to be an independent predictor of mortality in mechanically ventilated patients, the clinical benefits of DP-limited ventilation strategies compared with conventional lung protective ventilation (CLPV) for patients with acute respiratory distress syndrome/acute respiratory failure (ARDS/ARF) remain controversial.
methodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared DP-limited ventilation strategies with CLPV in patients with ARDS/ARF. The Cochrane Central Register of Controlled Trials, EMBASE, PubMed, Web of Science and Scopus databases were systematically searched from inception to June 2025. The primary outcome was short-term mortality.
resultsA total of 1417 records were identified, with 4 studies (n = 465) meeting the inclusion criteria. No significant differences in mortality outcomes, including 28-day mortality (4 RCTs, 465 patients; Odds ratio = 1.01; 95% Confidence interval [0.49, 2.10]; P = 0.98; I2 = 56%), intensive care unit (ICU) mortality (3 RCTs, 355 patients; Odds ratio = 1.24; 95% Confidence interval [0.81, 1.89]; P = 0.33; I2 = 36%), or in-hospital mortality (3 RCTs, 355 patients; Odds ratio = 1.21; 95% Confidence interval [0.79, 1.84]; P = 0.38; I2 = 0%), were observed between the groups. DP-limited ventilation was associated with a shorter length of ICU stay (4 RCTs, 465 patients; Mean difference =-2.95 days, 95% CI [-5.17, -0.74], P = 0.009; I2 = 7%). Analysis revealed no difference in ventilator-free days within 28 days (P = 0.86) and the length of hospital stay (P = 0.52) between the two ventilation strategies. Additionally, no significant difference in the incidence of barotrauma (P = 0.31) or acidosis (P = 0.43) was observed. The DP and tidal volume (Vt) were comparable between the groups.
conclusionsBased on current limited evidence, DP-limited ventilation showed no clear benefit over CLPV in patients with ARDS/ARF, with no survival benefit and a shorter length of ICU stay, warranting large RCTs to determine its clinical value, identify responsive clinical phenotypes, and establish standardized clinical application procedures.
trial registrationThe research plan was registered at PROSPERO, and the registration number is CRD420251069853.
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