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

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

doi:10.1186/s40635-025-00847-4

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

^*Corresponding author for this work

Maasstad Hospital
OLVG

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background:

In mechanically ventilated patients with acute respiratory distress syndrome (ARDS) it is of great importance to prevent ventilator-induced lung injury (VILI) using lung protective ventilation. VILI has been associated with a high mechanical power (MP). Flow-controlled ventilation (FCV) could play a role in decreasing the risk of VILI by lowering the MP and preventing atelectrauma by a controlled expiration.

Objectives:

To assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of ventilation distribution and homogeneity, measured by electrical impedance tomography (EIT).

Methods:

Randomized crossover physiological pilot study in ICU patients with a moderate to severe ARDS. Patients were randomized between 90 min of FCV followed by 90 min of PCV, or vice versa. Intratracheal and esophageal pressure, airway flow and EIT were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure–volume loops were constructed for the calculation of the MP.

Results:

In 10 patients, optimized FCV (compliance-guided driving pressure) versus PCV resulted in a similar MP (12.6 vs. 14.8 J/min; p = 0.302). A stable gas exchange at similar minute volumes was obtained. Optimized FCV resulted in increased tidal ventilation of the mid-ventral to dorsal regions compared to PCV, but EIT demonstrated a trend towards overdistension especially of the non-dependent lung regions. Because of this trend towards overdistension, severe hypercapnia in one patient, and inability to apply FCV as intended, the study was stopped early due to safety concerns.

Conclusions:

Optimized FCV compared with PCV resulted in a similar MP and tends towards overdistension in patients with moderate to severe ARDS. Trial registration: Clinicaltrials.gov identifier: NCT06051188. Registered 22 September 2023.

Original language	English
Article number	137
Journal	Intensive Care Medicine Experimental
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/s40635-025-00847-4
Publication status	Published - 24 Dec 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

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10.1186/s40635-025-00847-4Licence: CC BY

Flow-controlled ventilationFinal published version, 1.38 MBLicence: CC BY

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van Oosten, J. P., Francovich, J. E., Weller, D., Rietdijk, W., Goedendorp, N., Somhorst, P., den Uil, C. A., Gommers, D., Jonkman, A. H., & Endeman, H. (2025). Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients: a randomized crossover physiological study. Intensive Care Medicine Experimental, 13(1), Article 137. https://doi.org/10.1186/s40635-025-00847-4

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title = "Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients: a randomized crossover physiological study",

abstract = "Background:In mechanically ventilated patients with acute respiratory distress syndrome (ARDS) it is of great importance to prevent ventilator-induced lung injury (VILI) using lung protective ventilation. VILI has been associated with a high mechanical power (MP). Flow-controlled ventilation (FCV) could play a role in decreasing the risk of VILI by lowering the MP and preventing atelectrauma by a controlled expiration. Objectives: To assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of ventilation distribution and homogeneity, measured by electrical impedance tomography (EIT). Methods: Randomized crossover physiological pilot study in ICU patients with a moderate to severe ARDS. Patients were randomized between 90 min of FCV followed by 90 min of PCV, or vice versa. Intratracheal and esophageal pressure, airway flow and EIT were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure{\textendash}volume loops were constructed for the calculation of the MP.Results:In 10 patients, optimized FCV (compliance-guided driving pressure) versus PCV resulted in a similar MP (12.6 vs. 14.8 J/min; p = 0.302). A stable gas exchange at similar minute volumes was obtained. Optimized FCV resulted in increased tidal ventilation of the mid-ventral to dorsal regions compared to PCV, but EIT demonstrated a trend towards overdistension especially of the non-dependent lung regions. Because of this trend towards overdistension, severe hypercapnia in one patient, and inability to apply FCV as intended, the study was stopped early due to safety concerns.Conclusions: Optimized FCV compared with PCV resulted in a similar MP and tends towards overdistension in patients with moderate to severe ARDS. Trial registration: Clinicaltrials.gov identifier: NCT06051188. Registered 22 September 2023.",

author = "\{van Oosten\}, \{Julien P.\} and Francovich, \{Juliette E.\} and Dolf Weller and Wim Rietdijk and Nico Goedendorp and Peter Somhorst and \{den Uil\}, \{Corstiaan A.\} and Diederik Gommers and Jonkman, \{Annemijn H.\} and Henrik Endeman",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

day = "24",

doi = "10.1186/s40635-025-00847-4",

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van Oosten, JP , Francovich, JE, Weller, D, Rietdijk, W , Goedendorp, N , Somhorst, P , den Uil, CA , Gommers, D , Jonkman, AH & Endeman, H 2025, 'Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients: a randomized crossover physiological study', Intensive Care Medicine Experimental, vol. 13, no. 1, 137. https://doi.org/10.1186/s40635-025-00847-4

Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients: a randomized crossover physiological study. / van Oosten, Julien P.; Francovich, Juliette E.; Weller, Dolf et al.
In: Intensive Care Medicine Experimental, Vol. 13, No. 1, 137, 24.12.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Flow-controlled ventilation versus pressure-controlled ventilation in moderate to severe ARDS patients

T2 - a randomized crossover physiological study

AU - van Oosten, Julien P.

AU - Francovich, Juliette E.

AU - Weller, Dolf

AU - Rietdijk, Wim

AU - Goedendorp, Nico

AU - Somhorst, Peter

AU - den Uil, Corstiaan A.

AU - Gommers, Diederik

AU - Jonkman, Annemijn H.

AU - Endeman, Henrik

PY - 2025/12/24

Y1 - 2025/12/24

N2 - Background:In mechanically ventilated patients with acute respiratory distress syndrome (ARDS) it is of great importance to prevent ventilator-induced lung injury (VILI) using lung protective ventilation. VILI has been associated with a high mechanical power (MP). Flow-controlled ventilation (FCV) could play a role in decreasing the risk of VILI by lowering the MP and preventing atelectrauma by a controlled expiration. Objectives: To assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of ventilation distribution and homogeneity, measured by electrical impedance tomography (EIT). Methods: Randomized crossover physiological pilot study in ICU patients with a moderate to severe ARDS. Patients were randomized between 90 min of FCV followed by 90 min of PCV, or vice versa. Intratracheal and esophageal pressure, airway flow and EIT were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure–volume loops were constructed for the calculation of the MP.Results:In 10 patients, optimized FCV (compliance-guided driving pressure) versus PCV resulted in a similar MP (12.6 vs. 14.8 J/min; p = 0.302). A stable gas exchange at similar minute volumes was obtained. Optimized FCV resulted in increased tidal ventilation of the mid-ventral to dorsal regions compared to PCV, but EIT demonstrated a trend towards overdistension especially of the non-dependent lung regions. Because of this trend towards overdistension, severe hypercapnia in one patient, and inability to apply FCV as intended, the study was stopped early due to safety concerns.Conclusions: Optimized FCV compared with PCV resulted in a similar MP and tends towards overdistension in patients with moderate to severe ARDS. Trial registration: Clinicaltrials.gov identifier: NCT06051188. Registered 22 September 2023.

AB - Background:In mechanically ventilated patients with acute respiratory distress syndrome (ARDS) it is of great importance to prevent ventilator-induced lung injury (VILI) using lung protective ventilation. VILI has been associated with a high mechanical power (MP). Flow-controlled ventilation (FCV) could play a role in decreasing the risk of VILI by lowering the MP and preventing atelectrauma by a controlled expiration. Objectives: To assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of ventilation distribution and homogeneity, measured by electrical impedance tomography (EIT). Methods: Randomized crossover physiological pilot study in ICU patients with a moderate to severe ARDS. Patients were randomized between 90 min of FCV followed by 90 min of PCV, or vice versa. Intratracheal and esophageal pressure, airway flow and EIT were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure–volume loops were constructed for the calculation of the MP.Results:In 10 patients, optimized FCV (compliance-guided driving pressure) versus PCV resulted in a similar MP (12.6 vs. 14.8 J/min; p = 0.302). A stable gas exchange at similar minute volumes was obtained. Optimized FCV resulted in increased tidal ventilation of the mid-ventral to dorsal regions compared to PCV, but EIT demonstrated a trend towards overdistension especially of the non-dependent lung regions. Because of this trend towards overdistension, severe hypercapnia in one patient, and inability to apply FCV as intended, the study was stopped early due to safety concerns.Conclusions: Optimized FCV compared with PCV resulted in a similar MP and tends towards overdistension in patients with moderate to severe ARDS. Trial registration: Clinicaltrials.gov identifier: NCT06051188. Registered 22 September 2023.

UR - https://www.scopus.com/pages/publications/105025818710

U2 - 10.1186/s40635-025-00847-4

DO - 10.1186/s40635-025-00847-4

M3 - Article

C2 - 41442110

AN - SCOPUS:105025818710

SN - 2197-425X

VL - 13

JO - Intensive Care Medicine Experimental

JF - Intensive Care Medicine Experimental

IS - 1

M1 - 137

ER -

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

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