Respiratory failure & ventilation
Bedside personalized methods based on electrical impedance tomography or respiratory mechanics to set Positive End-Expiratory Pressure (PEEP) in acute respiratory distress syndrome (ARDS) and recruitment-to-inflation ratio: a physiologic study
Authors' conclusion
CoV and Express strategies led to higher PEEP levels than the Crossing Point and Positive PLe strategies. Optimal PEEP levels proposed by these four methods were not associated with recruitability.
Study context
- Population
- Patients with ARDS
- Participants
- 19 patients
- Comparison
- Electrical impedance tomography (EIT)-based vs respiratory mechanics-based PEEP titration strategies
- Outcome
- PEEP levels by each strategy and association with recruitability (R/Iest between PEEP 15 and 5 cmH2O)
Methodological detailsdecremental PEEP trial
- Decremental PEEP trial
Main finding
As reported in the abstract
Optimal PEEP level
Express
17
range 14–17
CoV
20
range 17–20
Positive PLe
8
range 5–11
Crossing Point
10
range 8–11
P < 0.001
Further findings
| Outcome | Express | Positive PLe | CoV | Crossing Point |
|---|---|---|---|---|
| Association of optimal PEEP level with R/Iest | ||||
| r2 | < 0.001 | 0.037 | < 0.001 | 0.073 |
| p | p = 0.920 | p = 0.461 | p = 0.941 | p = 0.263 |
Association of optimal PEEP level with R/Iest
- No significant association between optimal PEEP level and R/Iest for any strategy
Crossing Point PEEP and PEEP range of decremental trial
- Crossing Point PEEP level impacted by the PEEP range used during the decremental PEEP trial
Original publication
Bedside personalized methods based on electrical impedance tomography or respiratory mechanics to set PEEP in ARDS and recruitment-to-inflation ratio: a physiologic study. Ann Intensive Care. Published 5 January 2024. doi:10.
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