{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T15:53:27Z","timestamp":1782143607692,"version":"3.54.5"},"reference-count":63,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100022992","name":"Clinical Trials Fund, Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100022992","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,19]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute respiratory distress syndrome (ARDS) is a major public health problem, accounting for 23% of intubated patients and associated with high mortality rates. Although lifesaving, invasive mechanical ventilation can worsen lung injury when ventilator settings are poorly adjusted to lung physiology. We hypothesise that individualising ventilator settings via (1) the bedside assessment of lung recruitability using a one-breath derecruitment manoeuvre and measurement of airway opening pressure to set positive end-expiratory pressure (PEEP), (2) controlling the distending pressure and (3) controlling respiratory drive improves ARDS outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The CAreful Ventilation In ARDS trial is an investigator-led multicentre (33 centres in eight countries), open-label, randomised controlled basket trial comparing two ventilation strategies in two subpopulations of moderate-to-severe ARDS: induced or not by COVID-19. A total of 740 patients will be randomised (370 in each substudy) in a 1:1 ratio to individualised ventilator settings or to using traditional PEEP to inspired fraction of oxygen tables for PEEP setting. Indications for proning and weaning strategies are similar in both arms. The primary outcome is all-cause mortality at day 60. Secondary outcomes include duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital stay, organ dysfunction, barotrauma and mortality in ICU, at day 28 and in hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval has been obtained for all participating centres: Unity Health Toronto Research Ethics Board (for three centres: St Michael\u2019s Hospital, Toronto General Hospital and Toronto Western Hospital); Comit\u00e9 de \u00c9tica de Investigaci\u00f3n con Medicamentos del Hospital Universitari Vall d\u2019Hebron; Comit\u00e9 de protection des personnes Ile de France III; Comit\u00e9 d'\u00c9tica de la Investigatci\u00f3n con Medicamentos de la Fundaci\u00f3 de Gesti\u00f3 Sanit\u00e0ria del Hospital de la Santa Creu i Sant Pau; Comitato Etico\u2014Fondazione Policlinico Gemelli; Comitato Etico di Area Vasta Emilia Centro; NYU Langone Health Institutional Review Board; Comit\u00e9 \u00c9tico Cient\u00edfico de Ciencias de la Salud; Il Comitato Etico Area 1 dell\u2019Azienda Ospedaliero-Universitaria \u2018Ospedali Riuniti\u2019 di Foggia; HIGA \u2018Eva Per\u00f3n\u2019 Comit\u00e9 de Bio\u00e9tica; Comit\u00e9 de Revisi\u00f3n Institucional del Hospital Brit\u00e1nico Comit\u00e9 de \u00c9tica en Investigaci\u00f3n; Complejo M\u00e9dico Churruca-Visca Comit\u00e9 de \u00c9tica Biom\u00e9dica; Comit\u00e9 de \u00c9tica SATI Comit\u00e9 de \u00c9tica en Investigaci\u00f3n; Comit\u00e9 de \u00c9tica en Investigaci\u00f3n del CEMIC; Comit\u00e9 de \u00c9tica SATI Comit\u00e9 de \u00c9tica en Investigaci\u00f3n; Medical Research Ethics Committees United. Findings will be disseminated in peer review journals and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03963622\">NCT03963622<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115775","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:35:30Z","timestamp":1771853730000},"page":"e115775","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct03963622","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-1899","authenticated-orcid":false,"given":"R\u00e9mi","family":"Coudroy","sequence":"first","affiliation":[{"name":"M\u00e9decine Intensive et R\u00e9animation, CHU Poitiers, Poitiers, France"},{"name":"INSERM CIC1402, IS-ALIVE research group, Universit\u00e9 de Poitiers, Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Telias","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Respirology and Critical Care, Department of Medicine, University Health Network, Toronto, Ontario, 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