The following is a summary of “Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis,” published in the March 2024 issue of Critical Care by Songsangvorn et al.

Researchers conducted a retrospective study investigating whether electrical impedance tomography (EIT) can be used to optimize positive end-expiratory pressure (PEEP) settings for Acute Respiratory Distress Syndrome (ARDS) patients, potentially improving respiratory mechanics and reducing ventilator-induced lung injury (VILI) compared to traditional methods.

They searched Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS (January 2012 to May 2023). Assessing EIT-guided PEEP strategies in ARDS, thirteen studies (3 randomized, 10 non-randomized) examined 623 ARDS patients. Random-effects models analyzed primary outcomes (respiratory mechanics, mechanical power) and secondary outcomes (PaO₂/FiO₂ ratio, mortality, ICU stays, ventilator-free days).

The results showed that EIT-guided PEEP led to a significant increase in lung compliance (n = 941 cases, MD = 4.33, 95% CI [2.94, 5.71]), a decrease in mechanical power (n = 148, MD = − 1.99, 95% CI [− 3.51, − 0.47]), and a reduction in driving pressure (n = 903, MD = − 1.20, 95% CI [− 2.33, − 0.07]) compared to traditional methods. Sensitivity analysis demonstrated a consistent positive impact of EIT-guided PEEP on lung compliance in randomized clinical trials vs. non-randomized studies pooled (MD) = 2.43 (95% CI − 0.39 to 5.26), indicating improvement. Three studies linked a decrease in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) with modest enhancements in compliance and driving pressure.

Investigators concluded that EIT showed promise for personalizing PEEP, warranting more extensive trials for ARDS.

Source: link.springer.com/article/10.1007/s00134-024-07362-2