Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial
ART trial design and results
Design
Multicentre randomised trial
Treatment
Lung recruitment manoeuvre with PEEP titrated to best respiratory system static compliance
Control
Low PEEP strategy
Population
1010 patients with moderate to severe ARDS, mean age 50.9 years
Follow-up
6 months
Primary endpoint
28-day all-cause mortality
Result
Death at 28 days in 277 of 501 (55.3%) in the experimental group versus 251 of 509 (49.3%) in the control group — hazard ratio 1.20 (95% CI 1.01 to 1.42, p=0.041). Six-month mortality was also higher, 65.3% versus 59.9% (hazard ratio 1.18, 1.01 to 1.38, p=0.04), with fewer ventilator-free days.
In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients.
The trial authors, in the published abstract
How it has aged
The first major test of the open lung approach to show clear harm, and a corrective to the physiological reasoning that made recruitment manoeuvres attractive. Better oxygenation is not better outcomes. High mortality in both arms and the specific recruitment protocol used are the standing objections.
Publications
Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial
Cavalcanti AB, Suzumura ÉA, Laranjeira LN, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA 2017 Oct 10;318(14):1335-1345.