Positive-end expiratory pressure titration and transpulmonary pressure: the EPVENT 2 trial

The acute respiratory distress syndrome (ARDS) is an acute inflammatory lung edema. The current definition includes three severity stages based on PaO₂/FiO₂ ratio measured at positive end-expiratory pressure (PEEP) of 5 cmH₂O or more (1). ARDS was described for the first time by Ashbaugh et al. in 1967; it was suggested that PEEP could have beneficial effects (2). More than 50 years after its initial description ARDS is still of great concern for the intensivist because it accounts for 10% of ICU admissions and still supports a rough 40% mortality rate (3). Furthermore, ARDS can only be treated in the ICU environment because it very often requires invasive mechanical ventilation and because the mechanical ventilation settings can impact patient outcome.