{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:56:39Z","timestamp":1781326599903,"version":"3.54.1"},"reference-count":8,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute respiratory distress syndrome (ARDS), particularly in COVID-19\u2013related severe respiratory failure, remains a major challenge in intensive care. Flow-controlled ventilation (FCV) may improve gas exchange by enabling precise airway pressure control; however, clinical data on its prolonged use in ARDS are limited. Methods: This single-center retrospective observational study included adult patients with moderate to severe ARDS who underwent FCV during invasive mechanical ventilation. FCV was delivered using the Evone\u00ae ventilator with the Tritube\u00ae. Demographic data, ventilatory settings, and arterial blood gas values were analyzed before and during 48 h of FCV and for 8 h after transition to conventional ventilation. Results: Seven patients with COVID-19\u2013related ARDS were included. Following initiation of FCV, PaO2 increased within the first 8 h (median increase: +24 mmHg), accompanied by a median 38% improvement in the PaO2\/FiO2 ratio, which remained above baseline throughout follow-up. Arterial PCO2 progressively declined, with the most pronounced reduction observed within the first 24 h (median decrease: \u221214 mmHg; approximately 22%). After transition back to conventional ventilation, mild deterioration in gas exchange parameters was observed; however, none returned to baseline values. All patients died during their ICU stay, mainly due to secondary infections and pulmonary embolism. Conclusions: In advanced COVID-19\u2013related ARDS unresponsive to conventional ventilation, prolonged FCV application was technically feasible under controlled ICU conditions and associated with descriptively observed improvements in gas exchange parameters. However, late initiation of FCV did not translate into survival benefit. Prospective studies are required to define the optimal timing and patient selection for FCV. The present findings primarily support the technical feasibility and short-term physiological effects of FCV rather than clinical efficacy.<\/jats:p>","DOI":"10.3390\/jcm15124439","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:25:16Z","timestamp":1780935916000},"page":"4439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flow-Controlled Ventilation as a Rescue Strategy in Advanced COVID-19 ARDS: A Retrospective Observational Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-0714","authenticated-orcid":false,"given":"Meltem","family":"Ceylan Delice","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation 1, SBU Van Training and Research Hospital, Van 65000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9320-0778","authenticated-orcid":false,"given":"Nilgun","family":"Kavrut Ozturk","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation 2, SBU Antalya Training and Research Hospital, Antalya 07100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1359","DOI":"10.1097\/CCM.0000000000004561","article-title":"Pressure measurements in flow-controlled ventilation","volume":"48","author":"Enk","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Weber, J., Straka, L., Borgmann, S., Schmidt, J., Wirth, S., and Schumann, S. (2020). Flow-controlled ventilation (FCV) improves regional ventilation in obese patients: A randomized controlled crossover trial. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-0944-y"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40635-022-00449-4","article-title":"Flow-controlled ventilation in moderate acute respiratory distress syndrome due to COVID-19: An open-label repeated-measures controlled trial","volume":"10","author":"Morrison","year":"2022","journal-title":"Intensive Care Med. Exp."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Spraider, P., Putzer, G., Breitkopf, R., Abram, J., Mathis, S., Glodny, B., and Martini, J. (2021). A case report of individualized ventilation in a COVID-19 patient: New possibilities and caveats to consider with flow-controlled ventilation. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01365-y"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.mehy.2018.09.038","article-title":"Minimisation of dissipated energy in the airways during mechanical ventilation by using constant inspiratory and expiratory flows: Flow-controlled ventilation (FCV)","volume":"121","author":"Barnes","year":"2018","journal-title":"Med. Hypotheses"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1186\/s13054-017-1905-9","article-title":"Regional physiology of ARDS","volume":"21","author":"Gattinoni","year":"2017","journal-title":"Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s40635-020-00360-w","article-title":"Flow-controlled ventilation during EVLP improves oxygenation and preserves alveolar recruitment","volume":"8","author":"Ordies","year":"2020","journal-title":"Intensive Care Med. Exp."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40635-024-00616-9","article-title":"Flow-controlled ventilation decreases mechanical power in postoperative ICU patients","volume":"12","author":"Francovich","year":"2024","journal-title":"Intensive Care Med. Exp."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4439\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:15:13Z","timestamp":1781324113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":8,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124439"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124439","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}