EIT-Guided PEEP Optimization in Trauma and Postoperative ARDS
Electrical Impedance Tomography-Guided Positive End-Expiratory Pressure Optimization in Patients With Trauma-Related and Postoperative Acute Respiratory Distress Syndrome
Nguyen Dang Thu
80 participants
Mar 15, 2025
INTERVENTIONAL
Conditions
Summary
Acute respiratory distress syndrome (ARDS) remains a serious and often fatal complication in patients following severe trauma or major surgery. Mechanical ventilation is essential for supportive care in this population, but may aggravate lung injury when suboptimal ventilatory settings are applied. Positive end-expiratory pressure (PEEP) is crucial for maintaining alveolar recruitment; however, optimal PEEP selection in trauma- or postoperative-associated ARDS remains uncertain. Electrical impedance tomography (EIT) enables bedside, real-time assessment of regional ventilation and may support optimal PEEP titration by balancing alveolar overdistension and collapse. This study compares EIT-guided PEEP optimization with the conventional low FiO₂-PEEP strategy in terms of oxygenation and respiratory mechanics in patients with moderate to severe ARDS following trauma or surgery.
Eligibility
Inclusion Criteria1
- Mechanically ventilated surgical intensive care patients with trauma- or postoperative-associated moderate to severe ARDS, as defined by the 2023 Global Definition of ARDS.
Exclusion Criteria12
- Age <18 or >90 years.
- Severe acute brain injury or acute stroke with Glasgow Coma Scale <8.
- Thoracic trauma with pneumothorax or pneumomediastinum.
- End-stage diseases under palliative care (e.g., metastatic cancer, cirrhosis, end-stage renal disease).
- Severe multiorgan failure with expected survival <7 days.
- Conditions requiring prolonged mechanical ventilation (e.g., Guillain-Barré syndrome, cervical spinal cord injury).
- Contraindications to hypercapnia (e.g., elevated intracranial pressure, acute coronary syndrome).
- Prior use of advanced respiratory therapies (e.g., ECMO, inhaled nitric oxide, prone positioning, high-frequency ventilation).
- Pregnancy, breastfeeding, or skin lesions at electrode placement sites.
- Implanted electrical devices interfering with EIT (e.g., pacemaker, ICD).
- Known allergy to electrode materials.
- Refusal to participate or concurrent enrollment in another study
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Interventions
Device: electrical impedance tomography system (Enlight 2100, Timpel SA, Brazil). \- Patients underwent airway suctioning and were deeply sedated (RASS ≤ -3) to abolish spontaneous breathing. PEEP titration was performed using an EIT system (Enlight 2100, Timpel SA, Brazil), with a silicone belt containing 32 surface electrodes positioned at the fourth to fifth intercostal space in accordance with the manufacturer's instructions. Pressure-controlled ventilation was applied with an inspiration pressure set at 15 cmH₂O and a set PEEP of 24 cmH₂O, with a maximum airway pressure limit of 40 cmH₂O. Ventilator settings were maintained for 30 seconds with an FiO₂ of 1.0. A decremental PEEP trial was then performed by reducing PEEP in 2 cmH₂O every 30 seconds until a PEEP of 6 cmH₂O was reached or the SpO₂ decreased to ≤ 80%. The EIT-guided optimal PEEP was defined as the PEEP level corresponding to the intersection point of the collapse and overdistension curves.
PEEP was set and adjusted according to the lower PEEP/FiO₂ table of the ARDS Network
Locations(1)
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NCT07313644