REstricted Versus Liberal Positive End-Expiratory Pressure in Patients Without ARDS

You may not qualify if:

• Age less than 18 years
• Patients with a clinical diagnosis of ARDS or possible ARDS with a PaO2/FiO2 \< 200 mmHg (as the benefit of ventilation with higher PEEP levels has been proven in these patients)
• Patients with ongoing cardiac ischemia due to cardiac infarction and failed revascularization, patients with increased and uncontrollable intracranial pressure (of ≥ 18 mmHg), patients with delayed cerebral ischemia after subarachnoid hemorrhage, patients with necrotizing fasciitis, and severe untreatable anemia such as in case of Jehovah's Witnesses (as these patients can be considered to be vulnerable to the potentially dangerous hypoxemia which could develop more often, even for a short time, in the 'restricted PEEP'-arm of this trial)
• Patients previously randomized in this RCT
• Patients participating in another RCT with the same clinical endpoint, or interventions possibly compromising the primary outcome
• Invasive ventilation longer than 12 hours directly preceding the present ICU admission
• Invasive ventilation longer than 1 hour before randomization
• Patients with suspected or confirmed pregnancy
• Patients with morbid obesity (body mass index \> 40)
• Patients with GOLD classification III or IV chronic obstructive pulmonary disease (COPD)
• Patients with premorbid restrictive pulmonary disease (evidence of chronic interstitial infiltration on chest radiographs)
• Patients in whom pulse oximetry is known to be unreliable, e.g., patients with carbon monoxide poisoning
• Any neurologic diagnosis that can prolong duration of mechanical ventilation, e.g., patients with Guillain-Barré syndrome, high spinal cord lesion or amyotrophic lateral sclerosis, multiple sclerosis, or myasthenia gravis
• No informed consent