Respiratory failure & ventilation
Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO
Authors' conclusion
The R/I ratio is feasible during ultra-protective ventilation and provides valuable indications for guiding PEEP titration.
Study context
- Population
- Severe ARDS patients on venovenous ECMO, ventilated with very low tidal volumes
- Participants
- 54 ECMO patients
- Comparison
- R/I ratio vs Electrical Impedance Tomography (EIT)-based optimum PEEP
- Outcome
- Optimum EIT-based PEEP by R/I ratio tertile
Methodological detailsTidal volume 4.8 [3.0-6.0] mL/kg, R/I ratio from PEEP 15-5 cmH2O, then decremental PEEP trial 20-6 cmH2O in 2 cmH2O steps monitored by EIT
- Tidal volume 4.8 [3.0-6.0] mL/kg
- R/I ratio from PEEP 15-5 cmH2O, then decremental PEEP trial 20-6 cmH2O in 2 cmH2O steps monitored by EIT
Main finding
As reported in the abstract
- Weak inverse correlation of R/I ratio with EIT lung overdistension (R2)
- 0.19
- Positive correlation of R/I ratio with EIT lung collapse (R2)
- 0.26
Further findings
Airway opening pressure (AOP)
- Patients with AOP
- 13 (24%)
- AOP, cmH2O
- 11 (8-14)
R/I ratio, whole cohort
- Median R/I ratio
- 0.43 (0.28-0.61)
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO. Crit Care. Published 16 May 2025. doi:10.
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