Comparaison de deux stratégies d'utilisation de la pression expiratoire positive au cours du syndrome de détresse respiratoire aiguë. Étude ExPress. Présentation du protocole de l'étude

The best strategy for setting positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remains controversial. High levels of PEEP could protect the lung by avoiding the opening-closing phenomenon but might, on the other hand, increase the risk of overdistension and the deleterious hemodynamic consequences of positive intrathoracic pressure. The ExPress study is a multicenter randomized controlled trial comparing the effects on mortality of two strategies for setting PEEP in patients with ARDS. The same tidal volume (6 ml/kg) is used in the two strategies. The “maximal alveolar recruitment” strategy is aimed to optimize alveolar recruitment with a high level of PEEP. In this arm, PEEP is set to maintain plateau pressure close to the maximal currently recommended value of 30 cmH2O. In the “minimal alveolar distension” arm, the goal is to maximally decrease alveolar distension by using low to moderate levels of PEEP (total PEEP between 5 and 9 cm H2O). The goals for oxygenation and alveolar ventilation are the same in the two arms. Precise guidelines are used to titrate sedation and to conduct weaning. The main efficacy criteria is mortality on day 28. The protocol of the study plans to include 800 patients, recruited in 37 ICU.