Hui-Ju Hsu1,2, Hou-Tai Chang3, Zhanqi Zhao4,5, Ping-Huai Wang2, Jia-Hao Zhang3, Yun-Sung Chen3, Inéz Frerichs6, Knut Möller5, Feng Fu4, Han-Shui Hsu1,7, Shin-Ping Chuang2, Hai-Yen Hsia2, David Hung-Tsang Yen1,8. 1. Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. 2. Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan. 3. Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan. 4. Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, People's Republic of China. 5. Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany. 6. Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus Kiel, Germany. 7. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
OBJECTIVE: The aim of the study was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure-volume (PV) loop in moderate to severe acute respiratory distress syndrome (ARDS). APPROACH: Eighty-seven moderate to severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO2/FiO2 ≤ 200 mmHg) were randomized to either EIT group (n = 42) or PV group (n = 45). All patients received identical medical care using the same general support guidelines and protective mechanical ventilation. In the EIT group, the selected PEEP equaled the airway pressure at the intercept between cumulated collapse and overdistension percentages curves and in the PV group, at the pressure where maximal hysteresis was reached. MAIN RESULTS: Baseline characteristics and settings were comparable between the groups. After optimization, PEEP was significantly higher in the PV group (17.4 ± 1.7 versus 16.2 ± 2.6 cmH2O, PV versus EIT groups, p = 0.02). After 48 h, driving pressure was significantly higher in the PV group (12.4 ± 3.6 versus 10.9 ± 2.5 cmH2O, p = 0.04). Lung mechanics and oxygenation were better in the EIT group but did not statistically differ between the groups. The survival rate was lower in the PV group (44.4% versus 69.0%, p = 0.02; hazard ratio 2.1, confidence interval 1·1-3.9). None of the other pre-specified exploratory clinical endpoints were significantly different. SIGNIFICANCE: In moderate to severe ARDS, PEEP titration guided with EIT, compared with PV curve, might be associated with improved driving pressure and survival rate. TRIAL REGISTRATION: NCT03112512, 13 April, 2017.
OBJECTIVE: The aim of the study was to compare titration of positive end-expiratory pressure (PEEP) with electrical impedance tomography (EIT) and with ventilator-embedded pressure-volume (PV) loop in moderate to severe acute respiratory distress syndrome (ARDS). APPROACH: Eighty-seven moderate to severe ARDS patients (arterial oxygen partial pressure to fractional inspired oxygen ratio, PaO2/FiO2 ≤ 200 mmHg) were randomized to either EIT group (n = 42) or PV group (n = 45). All patients received identical medical care using the same general support guidelines and protective mechanical ventilation. In the EIT group, the selected PEEP equaled the airway pressure at the intercept between cumulated collapse and overdistension percentages curves and in the PV group, at the pressure where maximal hysteresis was reached. MAIN RESULTS: Baseline characteristics and settings were comparable between the groups. After optimization, PEEP was significantly higher in the PV group (17.4 ± 1.7 versus 16.2 ± 2.6 cmH2O, PV versus EIT groups, p = 0.02). After 48 h, driving pressure was significantly higher in the PV group (12.4 ± 3.6 versus 10.9 ± 2.5 cmH2O, p = 0.04). Lung mechanics and oxygenation were better in the EIT group but did not statistically differ between the groups. The survival rate was lower in the PV group (44.4% versus 69.0%, p = 0.02; hazard ratio 2.1, confidence interval 1·1-3.9). None of the other pre-specified exploratory clinical endpoints were significantly different. SIGNIFICANCE: In moderate to severe ARDS, PEEP titration guided with EIT, compared with PV curve, might be associated with improved driving pressure and survival rate. TRIAL REGISTRATION: NCT03112512, 13 April, 2017.
Authors: Hong Ren; Li Xie; Zhulin Wang; Xiaoliao Tang; Botao Ning; Teng Teng; Juan Qian; Ying Wang; Lijun Fu; Zhanqi Zhao; Long Xiang Journal: Front Med (Lausanne) Date: 2022-05-23