Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients: a randomised crossover physiological study

Authors: Julien P van Oosten, Juliette E Francovich, Dolf Weller, Wim Rietdijk, Nico Goedendorp, Peter Somhorst, Corstiaan A den Uil, Diederik Gommers, Annemijn H Jonkman, Henrik Endeman

Lung-protective ventilation is essential in patients with acute respiratory distress syndrome (ARDS) to reduce ventilator-induced lung injury, which has been associated with high mechanical power (MP). Flow-controlled ventilation (FCV), by actively controlling expiration, has been proposed as a strategy to reduce MP and limit atelectrauma. This randomised crossover physiological pilot study compared MP between FCV and pressure-controlled ventilation (PCV) in mechanically ventilated ICU patients with moderate to severe ARDS, and explored ventilation distribution using electrical impedance tomography (EIT).

In 10 patients, optimised FCV resulted in a mechanical power comparable to PCV, with stable gas exchange at similar minute ventilation. FCV shifted tidal ventilation towards mid-ventral and dorsal lung regions but was associated with a trend toward overdistension, particularly in non-dependent lung areas. Due to safety concerns—including overdistension, severe hypercapnia in one patient, and technical limitations—the study was stopped early. Overall, optimised FCV did not reduce mechanical power compared with PCV and may increase the risk of overdistension in moderate to severe ARDS.