To verify whether the transpulmonary pressure-guided mechanical ventilation strategy can reduce right ventricular involvement, especially the incidence of acute cor pulmonale (ACP), in patients with moderate to severe ARDS induced by pneumonia compared with the currently widely used right ventricular protective mechanical ventilation strategy.
Age ≥ 18 years old
ARDS caused by pneumonia (New Global Definition of ARDS)
PaO2/FiO2≤200mmHg
Received invasive mechanical ventilation
Invasive mechanical ventilation duration > 48 hours
History of pulmonary hypertension caused by various reasons
Severe arrhythmia
BMI>30kg/m2
Parallel
Transpulmonary pressure guided mechanical ventilation strategy
DeviceTidal volume is adjusted to achieve a target tidal volume of 6 mL/kg predicted body weight (PBW) while controlling end-inspiratory transpulmonary pressure ≤ 20 cmH₂O. PEEP is adjusted to maintain end-expiratory transpulmonary pressure between 0 and 2 cmH₂O. In control group, PEEP was titrated using the low PEEP:FiO₂ table method.
Incidence of right ventricular involvement within 28 days
Right ventricular involvement is defined as the presence of one of the following findings on transthoracic echocardiography: ACP: Right ventricular enlargement (RVED/LVED \> 0.6) with paradoxical septal motion; RVF: Right ventricular enlargement (RVED/LVED \> 0.6) accompanied by systemic venous congestion (CVP ≥ 8 mmHg), or if CVP is unavailable, inferior vena cava plethora; RVD: RV FAC \< 35%, or TAPSE ≤ 16 mm.
The respective incidence rates of ACP, RVF and RVD
ICU mortality
invasive mechanical ventilation duration
the number of participants receiving vasoactive agents
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