Positive End-Expiratory Pressure Setting in Adults with ALI and ARDS

The ExPress Trial examined the role of a positive end-expiratory pressure (PEEP) strategy targeting increased alveolar recruitment versus minimal alveolar distension in the treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Although lung protective ventilation in ALI and ARDS showed significant mortality benefit, the optimal PEEP strategy was unclear. The primary outcome of the study was 28 day mortality. Secondary outcomes included ventilator-free days, organ failure–free days, and barotrauma-related adverse events. Even though there was no significant difference in mortality between the two arms of the study, a significant difference was identified in ventilator-free days and organ failure–free days, which supported an increased recruitment PEEP strategy in the ALI/ARDS population and encouraged further examination.