Personalized Mechanical Ventilation Guided by UltraSound in Patients With Acute Respiratory Distress Syndrome
Trial Parameters
Brief Summary
Rationale Acute respiratory distress syndrome (ARDS) is a frequent cause of hypoxemic respiratory failure with a mortality rate of approximately 30%. The identification of ARDS phenotypes, based on focal or non-focal lung morphology, can be helpful to better target mechanical ventilation strategies of individual patients. Lung ultrasound (LUS) is a non-invasive tool that can accurately distinguish 'focal' from 'non-focal' lung morphology. The investigators hypothesize that LUS-guided personalized mechanical ventilation in ARDS patients will lead to a reduction in 90-day mortality compared to conventional mechanical ventilation.
Eligibility Criteria
Inclusion Criteria: * Admitted to a participating ICU, * invasively ventilated and * fulfil the Berlin criteria for moderate or severe ARDS. Exclusion Criteria: * Age under 18, * participation in other interventional studies with conflicting endpoints, * conditions in which LUS is not feasible or possible (e.g. subcutaneous emphysema, morbid obesity or wounds), * mechanical ventilation for longer than 7 consecutive days in the past 30 days, * history of ARDS in the previous month, * body-mass index higher than 40 kg/m², * intracranial hypertension, * broncho-pleural fistula, * chronic respiratory diseases requiring long-term oxygen therapy or respiratory support, * pulmonary fibrosis with a vital capacity \< 50% (severe or very severe), * previously randomized in the PEGASUS study * ECMO * patients who are moribund or facing end of life and * no informed consent.