Respiratory failure & ventilation
Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients
Authors' conclusion
In spontaneously breathing ARDS patients on PSV, the main determinants of tidal R/D are more negative PLEnd-Exp, higher lung collapse, and nonfocal infiltrates.
Study context
- Population
- Lightly sedated, spontaneously breathing acute respiratory distress syndrome (ARDS) patients on pressure support ventilation (PSV)30 original, 1 excluded
- Participants
- 29 participants
- Comparison
- Positive end-expiratory pressure (PEEP) selected by electrical impedance tomography (EIT) vs low PEEP/FiO2 table
Methodological detailsphysiological study, randomized PEEP levels, mixed-effects models, multivariable analysis
- Physiological study
- Randomized PEEP levels
- Mixed-effects models
- Multivariable analysis
Primary result
As reported in the abstract
Determinants of tidal R/D (multivariable analysis)
- More negative end-expiratory transpulmonary pressure (PLEnd-Exp) independently associated with tidal R/D
- Lung collapse independently associated with tidal R/D
- Nonfocal pattern independently associated with tidal R/D
Further findings
PEEP level
| Outcome | PEEPEIT | PEEPTABLE | P value |
|---|---|---|---|
| Tidal R/D by PEEP level | 11.3% (IQR 4.8–20.5) | 21.9% (IQR 6.8–31.7) | P = 0.008 |
- Tidal R/D by PEEP level — Overall tidal R/D
- 14.3% (IQR 9.0-33.0)
Correlates of R/D reduction with PEEPEIT
- Decrease in collapse (rho = 0.72)
- P < 0.001
- Decrease in pendelluft (rho = 0.57)
- P = 0.002
Mixed-effects models, both PEEPs (higher tidal R/D)
- Lower PEEP
- P < 0.001
- More negative PLEnd-Exp
- P < 0.001
- Larger collapse
- P < 0.001
- Lower lung compliance
- P = 0.002
- Higher respiratory drive
- P = 0.001
- Higher effort
- P = 0.009
- Higher dynamic driving transpulmonary pressure
- P = 0.009
- Nonfocal infiltrates
- P = 0.005
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients. Am J Respir Crit Care Med. Published 24 May 2026. doi:10.
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