Optimizing Positive End-Expiratory Pressure in Patients Without ARDS: From Non-Inferiority to Bayesian Probabilities of Benefit

MedXY Editorial Team•Apr 5, 2026•Clinical Updates

A Bayesian re-analysis of the RELAx trial reveals a 75% to 78% probability that a lower PEEP strategy (0–5 cm H2O) is superior to a higher PEEP strategy (8 cm H2O) for increasing ventilator-free days in patients without ARDS.
The probability of clinical benefit with lower PEEP exceeds 90% in specific subgroups, including patients not admitted for cardiac arrest and those intubated for reasons other than respiratory failure.
In patients with acute brain injury (ABI), higher PEEP is independently associated with increased odds of extubation failure and ICU mortality, reinforcing the need for restrictive PEEP strategies in this population.
While personalized PEEP titration (e.g., EIT or transpulmonary pressure-guided) shows promise in ARDS, evidence suggests that for the general non-ARDS ICU population, a lower, more restrictive PEEP approach is likely safer and more effective.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A Bayesian re-analysis of the RELAx trial reveals a 75% to 78% probability that a lower PEEP strategy (0–5 cm H2O) is superior to a higher PEEP strategy (8 cm H2O) for increasing ventilator-free days in patients without ARDS.
The probability of clinical benefit with lower PEEP exceeds 90% in specific subgroups, including patients not admitted for cardiac arrest and those intubated for reasons other than respiratory failure.
In patients with acute brain injury (ABI), higher PEEP is independently associated with increased odds of extubation failure and ICU mortality, reinforcing the need for restrictive PEEP strategies in this population.
While personalized PEEP titration (e.g., EIT or transpulmonary pressure-guided) shows promise in ARDS, evidence suggests that for the general non-ARDS ICU population, a lower, more restrictive PEEP approach is likely safer and more effective.