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We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cm HO, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. Treatment should be discontinued if the patient is sufficiently unstable to contraindicate the continued use of high PEEP levels. The necessary measures to minimize instability and adverse effects caused by the use of high PEEP levels should be implemented as deemed appropriate by the medical team. The random allocation list was generated in blocks (number of treatments per block will be kept confidential to avoid prediction of future patients’ allocation) and was stratified by investigator center age, and Pa O100). Couto; Fundação Hospitalar São Sebastião, Tres Corações-MG: Wesley S. Allocation concealment will be maintained by means of a web-based central, automated randomization system, available 24 h a day (ACT-Clinic), developed by a team of programmers and investigators from the Research Institute at Hospital do Coração (IEP-HCor). Bitencourt; Hospital Cônego Monte Raso, Baependi-MG: Wesley S.
Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial.
If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Carneiro; Carlos Castanelo, Edward Coelho Jr, Karine A.
Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.].
Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Winveler; Hospital Alfa, Recife-PE: Aldir Chagas Filho, Raphael Ali Cavalcanti; Hospital Evangélico de Londrina, Londrina-PR: Cintia M.
Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown.