6/28/23, 9:58 PM EPVent2 Pathway Feedback Search Clinical Topics Home Studies EPVent2 EPVent2 Disease Acute respiratory distress syndr Trial question What is the effect of titrating PEEP with an esophageal pressure-guided strategy among patients with moderate-to-severe ARDS? Study design Multi-center Open label RCT Population Characteristics of study participants 46.0% female N = 200 54.0% male 200 patients (92 female, 108 male) Inclusion criteria: mechanically ventilated patients aged 16 years and older with moderate-to- severe ARDS Key exclusion criteria: contraindication to esophageal instrumentation, high PEEP, severe coagulopathy, history of lung or liver transplantation, elevated ICP, neuromuscular disease, severe chronic liver disease Interventions N=102 esophageal-pressure guided mechanical ventilation (PEEP titration guided by esophageal pressure adjusted as needed to maintain end-expiratory PL between 0 to 6 cmH O) N=98 high PEEP mechanical ventilation (PEEP adjusted to maintain the lowest PEEP-FiO2 combination possible on the empirical table while maintaining oxygenation goals) P i t https://web.pathway.md/studies/recKrP7ijSghUV6w0 1/2 6/28/23, 9:58 PM EPVent2 Pathway Primary outcome Rate of death and days free from mechanical ventilation among survivors through day 28 50.4 % 50.4 49.6 37.8 % 25.2 % 12.6 % No significant difference 0.0 % Esophageal-pressure guided mechanical ventilation High PEEP mechanical ventilation No significant difference in the rate of death and days free from mechanical ventilation among survivors through day 28 (49.6% vs. 50.4%; ARD -0.8, 95% CI -15.14 to 13.54) Secondary outcomes No significant difference in the rate of death through day 28 (32.4% vs. 30.6%; AD 1.7%, 95% CI -11.1 to 14.6) Safety outcomes No significant differences in shock-free days, pneumothorax, barotrauma. Significant difference in rescue therapy (3.9% vs. 12.2%). Conclusion In mechanically ventilated patients aged 16 years and older with moderate-to-severe ARDS, esophageal-pressure guided mechanical ventilation was not superior to high PEEP mechanical ventilation with respect to the rate of death and days free from mechanical ventilation among survivors through day 28. Reference Jeremy R Beitler, Todd Sarge, Valerie M Banner-Goodspeed et al. Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2019 Mar 5;321(9):846-857. Open reference URL https://web.pathway.md/studies/recKrP7ijSghUV6w0 2/2