Management of ventilator and venovenous extracorporeal membrane oxygenation (ECMO) settings in critically ill adults requires individualized decisions to balance oxygenation, ventilation, and complication risks. Existing approaches rely heavily on clinician experience, with limited decision support tools available. An offline reinforcement learning agent trained on real-world venovenous ECMO clinical data can generate safe, interpretable, and clinically aligned recommendations for ECMO and ventilator management, including support for earlier and more efficient weaning. We conducted a retrospective study using electronic health record data from 184 adult patients who underwent venovenous ECMO at a tertiary care center. rECMOmender was developed using conservative Q-learning with a physiologically informed reward structure. Multiple model variants were compared across discrete and continuous action spaces and two reward formulations. Performance was assessed using fitted Q evaluation, comparison of action distributions, and alignment with clinician practice. rECMOmender generated stable, interpretable recommendations across five key parameters: Fio2, positive end-expiratory pressure (PEEP), respiratory rate, sweep gas flow, and blood flow rate. It selected Fio2 values in the 40-50% range most frequently (46.75% vs. 45.65% for clinicians) and favored PEEP of 9-11 cm H2O (43.94% vs. 34.28%), while using high PEEP settings (13-20 cm H2O) 73.43% less often. Compared with clinicians, rECMOmender increased large parameter shifts (> 1 bin) by 72.53% for Fio2, 348.15% for PEEP, 299.21% for respiratory rate, 96.68% for sweep gas, and 34.16% for blood flow, resulting in an overall 120.37% increase in major adjustments (3105 vs. 1409). rECMOmender demonstrated dynamic but safety conscious adjustments that aligned with clinical patterns, indicating potential as a decision support tool that complements clinician judgment.

Background Delivery of surfactant through a catheter, rather than an endotracheal tube, has been demonstrated to reduce mortality and also bronchopulmonary dysplasia, thereby reducing the requirement of intubation in the initial 72 h of life, and also decreasing the incidence of complications and mortality during hospitalisation. Evidence regarding the practicality and outcomes of this approach in resource-limited settings remains limited. To address this gap, we conducted a trial comparing the effectiveness of minimally invasive surfactant therapy (MIST) with the intubation–surfactant administration–extubation (InSurE) method in preterm infants with respiratory distress syndrome (RDS). Objective The objective of this study was to assess and contrast the effectiveness of MIST and InSurE method in delivering surfactant to preterm infants presenting with RDS. Methodology The study enrolled 192 preterm infants (28-34 weeks of gestation) who presented with RDS and met the inclusion criteria. All eligible neonates were managed with nasal continuous positive airway pressure (nCPAP), using a starting positive end-expiratory pressure of 5-6 cm H 2 O. The fraction of inspired oxygen (FiO 2 ) was titrated to achieve target oxygen saturation levels of 90%-95%. Infants who required FiO 2 levels exceeding 40% on nCPAP to sustain these saturations within the first 6 h of life were randomised to receive surfactant therapy through either the MIST approach or the InSurE technique. Subsequent clinical outcomes were then assessed. Results Within the study population, infants managed with the MIST approach exhibited significantly better outcomes compared to those treated using the InSurE technique. Specifically, the MIST group showed a lower requirement for mechanical ventilation ( p = .001), reduced incidence of bronchopulmonary dysplasia ( p = .03), pulmonary haemorrhage ( p = .02) and sepsis ( p = .004). In addition, these infants required a shorter duration of CPAP support and experienced reduced overall mortality ( p = .042). The length of oxygen therapy, however, remained comparable between the two groups. Conclusion MIST appears to be a superior alternative to the InSurE technique in preterm infants with RDS, as indicated by the notable reduction in the need for mechanical ventilation and overall mortality.

ObjectiveCardiopulmonary bypass (CPB), which induces pulmonary injury, significantly impacts the quality of life in patients undergoing cardiac surgery. Preventing and treating pulmonary complications has become a critical clinical issue. Optimizing ventilation strategies during the preoperative, intraoperative, and postoperative stages is essential for adequate lung protection and preventing CPB-related pulmonary injury.MethodsA comprehensive search of multiple databases including PubMed, Embase, and the Cochrane Library was conducted. After removing the duplicate studies, full-text review was performed, and all studies that reported mechanical ventilation strategies and lung protection during CPB were included.ResultsThis review systematically examines ventilation strategies during CPB, outlining optimized parameters and pharmacologic approaches across pre-, intra-, and post-CPB phases to reduce lung injury. Various modes - including volume control ventilation (VCV), pressure control ventilation (PCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG) - demonstrate unique benefits and limitations. When combined with protective measures (low tidal volume [LTV], moderate positive end-expiratory pressure [PEEP], and recruitment maneuvers), they show clinical efficacy in lung protection. Pharmacologic agents like ambroxol, neutrophil elastase inhibitors, and sivelestat further enhance protection, underscoring the promise of combined mechanical-pharmacological strategies against CPB-induced lung injury.ConclusionsA comprehensive approach integrating individualized ventilation management and pharmacological intervention is key to reducing CPB-induced lung injury, enhancing postoperative respiratory function, and improving patient outcomes.

The optimal level of positive end-expiratory pressure (PEEP) during venovenous extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) remains uncertain. This study aimed to evaluate the association between initial PEEP settings at ECMO initiation and the rate of successful ECMO liberation in patients with severe ARDS. We conducted a post hoc analysis of the multicenter Japan Chest CT for ARDS Requiring Venovenous ECMO (J-CARVE) registry. Adult patients with severe ARDS treated with venovenous ECMO between 2012 and 2022 at 24 institutions were included. Participants were categorized into three groups according to PEEP at ECMO initiation: low (< 8 cm H2O), middle (8-10 cm H2O), and high (> 10 cm H2O). The primary outcome was successful liberation from ECMO within 30 days. Multivariable Cox proportional hazards models were used to evaluate associations. Secondary outcomes included 60-day mortality, duration of ECMO support, and duration of mechanical ventilation. Among 683 patients analyzed, the overall ECMO liberation rate at 30 days was 69.2%. Liberation rates were 57.8% (103/178), 73.5% (259/352), and 72.5% (111/153) in the low, middle, and high PEEP groups, respectively. After adjustment, the low group had a significantly lower likelihood of successful ECMO liberation (hazard ratio [HR], 0.56; 95% CI, 0.39-0.81) compared with the middle group. No significant difference was observed between the high and middle groups (HR, 0.80; 95% CI, 0.58-1.10). The low group had longer ECMO duration; however, 60-day mortality and hospital length of stay did not differ significantly among groups. Lower PEEP levels at ECMO initiation were associated with reduced likelihood of successful ECMO liberation compared with moderate PEEP, whereas estimates for high vs. moderate PEEP were not statistically significant. These findings support avoiding insufficiently low PEEP and underscore the need for prospective studies to refine optimal PEEP strategies in patients with severe ARDS.

Associations of positive end-expiratory pressure (PEEP) with extubation failure and clinical outcomes in invasively ventilated patients with acute brain injury: A secondary analysis of the ENIO study.

This review aims to provide an overview of lung morphology classification in acute respiratory distress syndrome (ARDS) and morphology-guided mechanical ventilation. It discusses the distinct morphological subphenotypes, focal and nonfocal, and how they affect the selection and effectiveness of ventilation strategies. Computed tomography (CT) imaging has traditionally been used to differentiate ARDS morphologies, revealing that focal and nonfocal patterns respond differently to ventilation strategies such as positive end-expiratory pressure (PEEP) titration, recruitment maneuvers, and prone positioning. The Lung Imaging for Ventilator Setting (LIVE) trial highlighted the importance of correct morphology classification, showing that misclassification can obscure survival benefits from personalized ventilation. Lung ultrasound (LUS) has recently emerged as a viable, noninvasive tool for identifying morphological subtypes, with multiple classification methods demonstrating high accuracy. An ongoing trial is now evaluating LUS-based morphology classification to guide personalized mechanical ventilation. Accurate assessment of lung morphology is critical for morphology-guided mechanical ventilation in ARDS. LUS represents a promising tool to implement morphology-guided strategies at the bedside, but further validation is needed to ensure clinical benefit.

Mechanical ventilation in acute brain injury (ABI) requires simultaneous protection of the brain, lungs, and diaphragm. Recent studies have questioned whether conventional lung-protective settings are optimal in this population. This review summarizes emerging evidence and evolving strategies to personalize MV across the phases of ABI - from controlled ventilation to extubation and tracheostomy. The PROLABI randomized trial and the VENTIBRAIN study indicate that excessively low tidal volumes or high positive end-expiratory pressure may worsen outcomes in isolated ABI, highlighting the need for "protective windows" for ventilation. Dynamic indices such as driving pressure and mechanical power predict prognosis even in nonacute respiratory distress syndrome (ARDS) ABI. Novel approaches - including automated ventilation, respiratory drive monitoring, and individualized CO2 and O2 targets - are reshaping mechanical ventilation in ABI. Extubation failure remains frequent (~20%), largely due to impaired airway protection rather than gas-exchange parameters. Optimal mechanical ventilation in ABI demands individualized strategies balancing brain-lung-diaphragm interactions. Incorporating multimodal neuromonitoring, objective airway, drive assessment, and early rehabilitation may enhance patient safety, reduce secondary brain and pulmonary injury, and support timely liberation from mechanical ventilation.

Host responses during acute respiratory distress syndrome are highly heterogeneous, contributing to inconsistent therapeutic outcomes. Proteome-based phenotyping may identify biologically and clinically distinct phenotypes to guide precision therapy. In this multicentre cohort study, we used latent class analysis of targeted serum proteomics to identify acute respiratory distress syndrome phenotypes. Serum samples were collected within 72 h of diagnosis to capture early-phase profiles. Validation was conducted in external cohorts. Pathway enrichment assessed molecular heterogeneity. Lung computed tomography scans were analysed using machine learning-based radiomics to explore phenotypic distinctions. Heterogeneous treatment effects for glucocorticoids and ventilation strategies were evaluated using inverse probability of treatment weighting adjusted Cox regression. A multinomial XGBoost model was developed to classify phenotypes. Among 1048 patients, three inflammatory phenotypes (C1, C2, C3) were identified and validated in two independent cohorts. The phenotype C1, with a larger proportion of poorly/non-inflated lung compartments, had the highest 90-day mortality and shock incidence and fewest ventilator-free days, followed by C3, while C2 patients had the best outcomes (p<0.001). Phenotype C1 was characterised by intense innate immune activation, cytokine amplification and metabolic reprogramming. Phenotype C2 demonstrated immune suppression, enhanced tissue repair and restoration of anti-inflammatory metabolism. Phenotype C3, comprising the oldest patients, reflected an intermediate state with moderate immune activation and partial immune resolution. Glucocorticoid therapy and higher positive end-expiratory pressure ventilation improved 90-day outcomes in C1 but increased mortality in C2 patients (pinteraction<0.05). Finally, a 12-biomarker classifier can accurately distinguish phenotypes. We identified and validated three proteome-based acute respiratory distress syndrome phenotypes with distinct clinical, radiographic and molecular profiles. Their differential treatment responses highlight the potential of biomarker-driven strategies for acute respiratory distress syndrome precision medicine.

During bronchoscopy in mechanically ventilated patients, bronchoscope insertion markedly increases airway resistance, elevating peak airway pressure and reducing delivered tidal volume. We sought todetermine whether specific ventilator settings (assist volume-controlled with reduced inspiratory flow and tidal volume) lower serious adverse events during flexible fiberoptic bronchoscopy compared with conventional ventilator settings. Single-center randomized adjudicator-blinded controlled trial in intubated adult patients undergoing fiberoptic bronchoscopy. Patients were assigned (1:1) to bronchoscopy-optimized settings (inspiratory flow ≤ 25L/min, tidal volume = 5mL/Kg, 1s ≤ inspiratory time ≤ 1.3s, respiratory frequency = 16 breaths/min, positive end-expiratory pressure = 5cmH2O) or to conventional ventilator settings. The primary endpoint was a composite of serious adverse events requiring premature termination (inability to deliver ventilatory support, significant arterial desaturation, or hemodynamic instability), adjudicated by blinded experts. All analyses were performed on an intention-to-treat basis. The primary composite endpoint occurred in 1/23 (4%) with optimized settings compared with 22/23 (96%) with conventional settings (risk difference -91.3%; risk ratio 0.05; p < 0.001). Events were driven by ventilatory failure due to pressure-alarm limitation, with lower delivered tidal volume (median 160 vs 400 mL; p < 0.001) and minute ventilation (3.2 vs 7.2 L/min; p < 0.001) under conventional settings. Respiratory and circulatory events were rare and similar between groups (each 1/23 [4%]). Among 19 crossover patients, switching to optimized settings reduced peak airway pressure and restored adequate ventilation. A bronchoscopy-optimized ventilation strategy substantially reduces pressure-alarm-limited ventilation events and enables the delivery of adequate ventilatory support during fiberoptic bronchoscopy.

Weaning from invasive mechanical ventilation (IMV) is challenging and has multiple causes. The diaphragm is the main respiratory muscle for inspiration. This prospective study aimed to determine the value of standardized diaphragm ultrasound (DUS) measurements [diaphragm excursion (DE), diaphragm thickness fraction (DTF), diaphragmatic rapid shallow breathing index (D-RSBI), rapid shallow diaphragmatic index (RSDI)] in predicting extubation success in intensive care patients, both individually and in combination with conventional indices [rapid shallow breathing index (RSBI), dynamic compliance (Cdyn), airway occlusion pressure, semi-quantitative cough strength score]. To isolate diaphragm contribution, only neurologically intact patients (Glasgow Coma Scale > 14) with adequate airway protection reflexes were included. The second aim was to examine the relationship between IMV and DUS measurements. 151 patients on IMV for > 24h and eligible for spontaneous breathing trial (SBT) were evaluated. Following exclusion criteria, patients underwent SBT in pressure support ventilation mode (positive end-expiratory pressure 5 cmH2O, pressure support 8 cmH2O). During SBT, mechanical ventilation parameters and diaphragm ultrasound measurements were recorded. Extubation failure was defined as need for reintubation or non-invasive ventilation. DE and DTF were significantly higher, D-RSBI was lower in patients with successful extubation. There was no difference in RSDI. Multivariate logistic regression was statistically significant, odds ratios (10.018, 1.109, 1.094) were found for DE, DTF, Cdyn, respectively. The only significant correlation between IMV and DUS was DTF-tidal volume (r = - 0.500). A standardized multiparametric model, combining DUS with conventional indices, provides moderate predictive accuracy for extubation success. Integrating DUS into weaning protocols can improve extubation readiness.

The effect of different spontaneous breathing trial (SBT) methods on lung volume and ventilation distribution has not been well clarified in post-cardiac surgery patients. In this prospective observational study, patients underwent 30min of pressure-support ventilation (PSV)-SBT [PS 8cmH2O, zero positive end-expiratory pressure (ZEEP)], followed by a 30-min T-piece trial if tolerated. Electrical impedance tomography (EIT) was used to continuously monitor regional lung ventilation and end-expiratory lung volume (EELV) at baseline, PSV-SBT 3min, PSV-SBT 30min, T-piece SBT 3min and T-piece SBT 30min. EELVloss = [VTbaseline/tidal impedance variation (TIV)baseline] × ΔEELI. EELVloss PSV was defined as volume loss at 30min of PSV-SBT and EELVloss T-piece was defined as volume loss during T-piece SBT. In 60 patients who complied with both SBT steps, 43 succeeded (71.7%) and 17 failed (28.3%) the T-piece SBT. Compared to the success group, the failure group exhibited a higher incidence of pendelluft (52.9% vs. 23.3%, p = 0.045) and significantly greater EELVloss at T-piece SBT 30min (623[459,746] ml vs. 511[376,702]ml, p = 0.003). However, the success group showed greater EELVloss PSV than the failure group (322[247,459] ml vs. 199[166, 269] ml, p < 0.001), which was an abnormal pattern. Notably, the failure group had lower TIV (2102[1769,2562] vs. 2742[2153,3872], p = 0.005) and a higher respiratory rate (RR) than baseline at PSV-SBT 30min (20[17,24] vs. 16[12,18], p < 0.001). Furthermore, we classified all patients into two groups based on the predominant reduction of volume loss: P-volume loss group (N = 37, EELVloss PSV > EELVloss T-piece) and T-volume loss group (N = 23, EELVloss T-piece > EELVloss PSV). In addition, the T-volume loss group had a higher weaning failure rate than the P-volume loss group (52.2% [12/23] vs. 13.5% [5/37], p < 0.001) and was associated with reduced baseline dorsal ventilation (39%[37%,43%] vs. 44%[41%,50%], p = 0.023). ROC analysis suggested that a dorsal ventilation threshold of 40.5% was associated with T-volume loss. The successful weaning patients had a higher reduction of EELVloss PSV and a lower reduction of EELVloss T-piece. In the weaning failure patients, the paradox of lower EELVloss PSV that was accompanied by a high RR and low VT might be associated with air trapping. Attention should be paid to using EELVloss PSV to identify weaning failure.

BackgroundOut-of-hospital cardiac arrest (OHCA) remains a major cause of mortality, with low survival probabilities to hospital discharge. Despite the frequent use of airway management and mechanical ventilation during resuscitation, there is limited evidence regarding the optimal ventilation strategy to improve oxygen delivery and patient outcomes. The present study aims to investigate the effects of positive-end-expiratory-pressure (PEEP) set at 5 mbar compared to zero-end-expiratory-pressure (ZEEP) on the return of spontaneous-circulation (ROSC) in adult patients with OHCA.MethodsThis is a prospective, multicenter, cluster-randomized controlled trial conducted across emergency medical services (EMS) in the regions of Gütersloh, Minden-Lübbecke, and Osnabrück. Adult patients (≥ 18 years) with OHCA who are undergoing mechanical ventilation through an airway device will be enrolled. The clusters (regional districts) will be randomized into two groups: one group will receive ventilation with PEEP set at 5 mbar (intervention group), while the other group will receive ventilation with ZEEP (control group). The study’s primary endpoint is the occurence of ROSC. Secondary endpoints include occurence of re-arrest, death during pre-hospital care phase, hospital admission during ongoing resuscitation, hospital admission with spontaneous circulation, peripheral oxygen saturation, and endtidal CO2 at hospital admission.DiscussionOptimal ventilation strategies during OHCA have not been well established. The use of PEEP may improve oxygenation and oxygen delivery. This study aims to provide crucial data on whether the application of PEEP at 5 mbar vs. 0 mbar can improve the probability of ROSC without adversely affecting hemodynamics. The findings could inform future guidelines on ventilation strategies in resuscitation.Trial registrationThe trial is registered on ClinicalTrials.gov under the registration number NCT06836830. 24.02.2025 https://clinicaltrials.gov/study/NCT06836830?term=gerrit%20jansen&rank=2.

To investigate the association between dynamic driving pressure (ΔPdyn) and mortality in mechanically ventilated patients with acute brain injury (ABI), and to evaluate whether neurological and pulmonary injury severity modify this relationship. This prespecified secondary analysis of the VENTIBRAIN prospective study (NCT04459884) included mechanically ventilated adult patients with ABI (traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage, or ischemic stroke). ΔPdyn was calculated daily over the first 14 days as peak inspiratory pressure minus positive end-expiratory pressure (PEEP). Bayesian joint models evaluated the time-varying association between ΔPdyn and mortality at ICU discharge, hospital discharge, and 6months. Secondary analyses evaluated effect modification by baseline Glasgow Coma Scale (GCS), PaO₂/FiO₂, and ABI subtype. Among 1,555 patients (median age 59 years, 34.5% female), higher time-varying ΔPdyn was associated with increased ICU mortality (hazard ratio [HR], 1.057 per daily 1cmH2O; 95% credible interval, 1.037-1.078; posterior probability of HR > 1, 99.9%). Findings were consistent across all ABI subtypes and were similar for static ΔP (plateau pressure minus PEEP). The association was strongest in patients with severe ABI (GCS ≤ 8) and severe hypoxemia (PaO₂/FiO₂ ≤ 100). Results were robust across all outcome timepoints and multiple sensitivity analyses. Higher time-varying ΔPdyn was associated with increased mortality in this cohort of patients with ABI. Neurological injury severity independently modified the harm from ΔPdyn with a magnitude comparable to severe hypoxemia. Measurement of ΔPdyn may aid risk stratification and ventilation strategies in ABI; future trials should evaluate the effect of reducing ΔPdyn in this population.

Patients undergoing on-pump cardiac surgery are at high risk for perioperative lung injury and a hyperinflammatory state associated with postoperative complications. The authors investigated the hypothesis that flow-controlled ventilation (FCV) reduces the inflammatory stimulus compared to conventional pressure-controlled ventilation (PCV) in this patient cohort. FCV has the unique feature of controlling airway flows during inspiration and expiration and the potential to reduce mechanical power of invasive ventilation. In this single-center randomized controlled trial, 140 adult patients undergoing cardiac surgery with cardiopulmonary bypass were allocated 1:1 to FCV or PCV from August 10, 2020, to November 16, 2022. Participants received perioperatively either individualized FCV with a compliance-guided positive end-expiratory pressure (PEEP) and a compliance-guided driving pressure (ΔP) or PCV with a compliance-guided PEEP and ΔP for tidal volumes of 6 to 8 ml/kg predicted body weight. Postoperative plasmatic interleukin 8 (IL-8) levels 6 h after cardiopulmonary bypass were defined as the primary endpoint. Explorative secondary outcomes included incidences of postoperative pulmonary and extrapulmonary complications and hospital length of stay. Median postoperative IL-8 levels did not differ significantly between FCV and PCV (FCV, 3.08 vs . PCV, 3.60; β, 0.08 pg/ml; 95% CI, -0.17 to 0.33; P = 0.573). ΔP values and tidal volumes were higher in the FCV group but FCV yielded lower respiratory rates and minute volumes required for normocapnia. As a result, the FCV approach reduced the perioperatively applied mechanical power by 55%. After FCV, incidences of single postoperative pulmonary complications ( e.g. , confirmed pneumonia, moderate and severe hypoxemia) and any postoperative extrapulmonary complication were lower and the hospital stay shorter. FCV did not reduce plasmatic IL-8 levels at the predefined timepoint 6 h after cardiopulmonary bypass. However, the reduction of mechanical power during individualized FCV application and the findings of the explorative secondary study outcomes justify future trials.

Association of right ventricular dysfunction on electrocardiogram with outcomes and ventilatory response in patients monitored by electrical impedance tomography: A cohort study.

Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial.

Vulnerabilities of feature clustering in EIT radiomics.

Differences in mechanical ventilation strategies between patients with and without acute brain injury (ABI) remain incompletely characterized. We aimed to compare ventilation approaches in patients with and without ABI over a 10-year period and to investigate impacts of practice changes on Pa o2 and Pa co2 . Retrospective registry-based cohort study involving prospectively collected data from nine ICUs across Toronto, Ontario, Canada. Adult patients (≥ 18 yr) receiving invasive ventilation for at least 48 hours from 2014 to 2023 were included. Patients were classified as having ABI (exposure) or non-ABI (comparator) conditions. Between-group differences in tidal volume (V t ), positive end-expiratory pressure (PEEP), Pa co2 , and Pa o2 were summarized using adjusted linear mixed-effects regression. Six additional ventilation and gas exchange variables were evaluated in unadjusted analyses. None. Thirteen thousand nine hundred twenty-five patients were included. Mean age ( sd ) was 59.1 years (17.5 yr), 38.1% of patients ( n = 5305) were female, and 25.2% had ABI ( n = 3503). Over the first 7 ventilation days, V t was comparable between groups, with a daily median close to 6 mL/kg (interquartile range, 6-7 mL/kg) predicted body weight. PEEP was significantly lower in patients with ABI (median 5 vs. 8 cm H 2 O in non-ABI patients; p < 0.001). Among patients with hypoxemic respiratory failure, PEEP remained significantly lower in the ABI subset. From 2014 to 2023, V t decreased slightly in both groups, while PEEP remained unchanged. Pa co2 was largely maintained within 35-45 mm Hg in ABI patients and Pa o2 remained largely within 80-120 mm Hg. Differences in six additional ventilation parameters between groups were minimal. Both ABI and non-ABI patients received comparable V t that trended downwards over time. Pa co2 and Pa o2 remained largely within guideline-recommended ranges. However, PEEP was significantly lower in ABI patients, including among those with hypoxemic respiratory failure, highlighting potential opportunities to improve PEEP application in relevant subsets.

Optimising positive end-expiratory pressure in acute respiratory distress syndrome: a narrative review of approaches to titration.

Correlation analysis of central venous pressure and intrathoracic pressures in acute respiratory distress syndrome mechanical ventilated patients, a pilot study