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Reducing ventilator-associated lung injury by individualized mechanical ventilation (MV) in patients with Acute Respiratory Distress Syndrome (ARDS) remains a matter of research. We randomly assigned 27 pigs with acid aspiration-induced ARDS to three different MV protocols for 24 h, targeting different magnitudes of collapse and tidal recruitment (collapse&amp;TR): the ARDS-network (ARDSnet) group with low positive end-expiratory pressure (PEEP) protocol (permissive collapse&amp;TR); the Open Lung Concept (OLC) group, PaO 2 /FiO 2 &gt;400 mmHg, indicating collapse&amp;TR &lt;10%; and the minimized collapse&amp;TR monitored by Electrical Impedance Tomography (EIT) group, standard deviation of regional ventilation delay, SD RVD . We analyzed cardiorespiratory parameters, computed tomography (CT), EIT, and post-mortem histology. Mean PEEP over post-randomization measurements was significantly lower in the ARDSnet group at 6.8 ± 1.0 cmH 2 O compared to the EIT (21.1 ± 2.6 cmH 2 O) and OLC (18.7 ± 3.2 cmH 2 O) groups (general linear model (GLM) p &lt; 0.001). Collapse&amp;TR and SD RVD , averaged over all post-randomization measurements, were significantly lower in the EIT and OLC groups than in the ARDSnet group (collapse p &lt; 0.001, TR p = 0.006, SD RVD  p &lt; 0.004). Global histological diffuse alveolar damage (DAD) scores in the ARDSnet group (10.1 ± 4.3) exceeded those in the EIT (8.4 ± 3.7) and OLC groups (6.3 ± 3.3) ( p = 0.16). Sub-scores for edema and inflammation differed significantly (ANOVA p &lt; 0.05). In a clinically realistic model of early ARDS with recruitable and nonrecruitable collapse, mechanical ventilation involving recruitment and high-PEEP reduced collapse&amp;TR and resulted in improved hemodynamic and physiological conditions with a tendency to reduced histologic lung damage.

Mechanical Ventilation Strategies Targeting Different Magnitudes of Collapse and Tidal Recruitment in Porcine Acid Aspiration-Induced Lung Injury