Evidence map›Paper›PMID 41787551›Full record

SynthesisCritical care (London, England)2026

Effect of driving pressure-limiting strategies on outcomes of patients with ARDS: a meta-analysis of randomized controlled trials.

Michalis Agrafiotis, Michail Georgopoulos, Evangelia Akoumianaki, Ilias I Siempos

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Michalis AgrafiotisDepartment of Anesthesiology and Intensive Care, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Michail GeorgopoulosFirst Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, 45-47 Ipsilantou Street, Athens, 10676, Greece.
Evangelia AkoumianakiDepartment of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete, Heraklion, Greece.
Ilias I SiemposFirst Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, 45-47 Ipsilantou Street, Athens, 10676, Greece. isiempos@yahoo.com.

Funding

Hellenic Thoracic Society 2023
6 · The paper itself

Abstract

backgroundLower driving pressure is associated with better outcomes in patients with acute respiratory distress syndrome (ARDS) based on observational studies. However, individual randomized controlled trials provided inconclusive evidence. We synthesized evidence from randomized controlled trials to examine whether implementation of driving pressure-limiting strategies is feasible and improves outcomes.

methodsThis meta-analysis was registered with PROSPERO (CRD420251141653). PubMed, Scopus, CENTRAL and references were searched for trials comparing driving pressure-limiting strategies on top of lung protective ventilation ("intervention" group) versus lung protective ventilation alone ("control" group) in ARDS. Outcomes were feasibility of intervention, all-cause mortality, ventilator-free days and length of intensive care unit (ICU) stay.

resultsFour trials, enrolling 431 patients and implementing heterogenous driving pressure-limiting strategies (namely, tidal volume reduction and/or positive end-expiratory pressure titration), were included. There were no statistically significant mean differences in post-randomization driving pressure (namely, - 2.17, - 2.09 and - 2.15 cmH

conclusionsWhen lung protective ventilation is already applied, further limitation of driving pressure may be hard to achieve. This inability to meaningfully limit driving pressure might explain the neutral effect of driving pressure-limiting strategies on outcomes, such as mortality and ventilator-free days.

Indexed as

Positive-Pressure RespirationRespiratory Distress SyndromeHumansIntensive Care UnitsRandomized Controlled Trials as TopicRespiration, ArtificialTidal VolumeAcute hypoxemic respiratory failureAcute respiratory distress syndromeLung injury

Identifiers

PMID41787551
PMCPMC13072659

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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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.