ArticleIntensive care medicine experimental2025
Personalized mechanical ventilation guided by lung ultrasound in patients with ARDS: a pilot phase of a randomized clinical trial.
Article in Intensive care medicine experimental, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05492344 (Personalized Mechanical Ventilation Guided by UltraSound in Patients With Acute Respiratory Distress Syndrome), which is not on this map. Cited by 4 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
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.
Personalized Mechanical Ventilation Guided by UltraSound in Patients With Acute Respiratory Distress Syndrome
Who cites it
4 citing papers in PubMed.
- PEEP and alveolar recruitment after 60 years of acute respiratory distress syndrome.Intensive care medicine · 2026Review
- From physiological innovation to clinical precision: defining the right target for diaphragm neurostimulation.Journal of thoracic disease · 2026Article
- Beyond One-Size-Fits-All: Precision Mechanical Ventilation in ARDS.Journal of clinical medicine · 2026Review
- Advances in bedside imaging: lung ultrasound.Intensive care medicine experimental · 2025Review
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Authors and funding
37 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe "Personalized Mechanical Ventilation Guided by Lung UltraSound in Patients with Acute Respiratory Distress Syndrome" (PEGASUS) study aims to evaluate personalized mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) compared to the standard of care. However, misclassification and misaligned MV strategies were shown to be harmful. We therefore aimed to assess the interobserver agreement of lung ultrasound (LUS) between the local investigator and an expert panel in classifying ARDS subphenotypes alongside protocol adherence and safety endpoints, as a pilot phase of the ongoing PEGASUS study.
methodsThe first 80 mechanically ventilated patients with moderate-to-severe ARDS were enrolled in the ongoing PEGASUS study, a randomized clinical trial (RCT), and were included in the pilot phase. Focal or non-focal subphenotypes were classified using a LUS. Positive end-expiratory pressures (PEEP), tidal volumes (VT), the application of recruitment manoeuvres, and proning were performed according to randomization arm and subphenotype. Safety limits for MV followed current guidelines. Agreement in subphenotype classification between local investigators and a panel of three experts was evaluated using Cohen's κ coefficient.
resultsIn 68 out of 80 exams, the images were of sufficient quality for assessment. The interobserver agreement for the lung morphology had a Cohen's kappa of 0.72 (95% CI 0.53-0.9) and accuracy of 88% between local investigator and the expert panel. Misclassification occurred in 8/68 exams (11.8%). Among these 8 misclassified cases, 6 (75%) also showed disagreement between experts due to different LUS scores of the anterior regions. Tidal volume and PEEP were generally set according to the protocol. An exception was the TV in the non-focal ARDS patients randomized to personalized MV, where the median (6.2 ml/kg/PBW) was above the target range (4-6 ml/kg/PBW). Patients exceeding safety limits of MV were low.
conclusionIn the pilot phase of an ongoing international subphenotype-targeted RCT, we found that local investigators' assessments agreed with expert panel consensus assessments in the large majority of cases, and nearly always when the expert panel assessment was unanimous. Protocol adherence was sufficient, but tidal volume in the non-focal subphenotype deserves attention during continuation of the study.
trial registrationThe study was registered on clinicaltrial.gov (ID: NCT05492344, date 2022-08-05).
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