Multicentre, parallel, open-label, two-arm, randomised controlled trial on the prognosis of electrical impedance tomography-guided versus low PEEP/FiO2 table-guided PEEP setting: a trial protocol

Wong, HouPeng; Chi, Yi; Zhang, Rui; Yin, Chengfen; Jia, Jianwei; Wang, Bo; Liu, Yi; Shang, You; Wang, Rui; Long, Yun; Zhao, Zhanqi; He, Huaiwu

doi:10.1136/bmjopen-2023-080828

Cited by 2 publications

References 42 publications

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Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions

Scaramuzzo,

Pavlovsky,

Adler

et al. 2024

Crit Care

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Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and management of various respiratory conditions and lung perfusion. Its application may be especially beneficial for critically ill mechanically ventilated patients. Despite its potential, clear evidence of clinical benefits is still lacking, in part due to a lack of standardization and transparent reporting, which is essential for ensuring reproducible research and enhancing the use of EIT for personalized mechanical ventilation. This report is the result of a four-day expert meeting where we aimed to promote the consistent and reliable use of EIT, facilitating its integration into both clinical practice and research, focusing on the adult intensive care patient. We discuss the state-of-the-art regarding EIT acquisition and processing, applications during controlled ventilation and spontaneous breathing, ventilation-perfusion assessment, and novel future directions.

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Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions

Scaramuzzo,

Pavlovsky,

Adler

et al. 2024

Crit Care

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The influence of BMI on optimal PEEP titrated by electrical impedance tomography in ARDS patients

Zhao,

Chi,

Yuan

et al. 2024

Preprint

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Background Obese patients with acute respiratory distress syndrome (ARDS) may require higher positive end-expiratory pressure (PEEP), but the dose-response relationship between body mass index (BMI) and PEEP remains undetermined. This study aimed to investigate the relationship between BMI and the optimal PEEP titrated by electrical impedance tomography (EIT) in ARDS patients. Methods ARDS patients who underwent EIT-guided PEEP titration were analyzed retrospectively. Patients were classified as obese (BMI ≥ 28 kg/m²) and non-obese (BMI < 28 kg/m²). All patients received a decremental PEEP trial from 18 to 3 cmH2O, and the optimal PEEP was determined by the lowest sum of EIT-based regional overdistension and collapse. Results Among 115 ARDS patients reviewed, average BMI was 25.1 (22.4–28.0) kg/m2, ranging from 16.0 to 38.1 kg/m2, with 29 (25.2%) patients being obese. Compared to non-obese patients, the titrated PEEP was higher in obese patients (12 [12–15] cmH2O vs 9 [6–12] cmH2O, p < 0.001). At the PEEP level of 3 cmH2O, the proportion of collapse in obese group was higher than in the non-obese group (39.0 [31.0-48.2] % vs 27.5 [18.3–40.7] %, p = 0.004). At the PEEP level of 18 cmH2O, overdistension was lower in obese group (18.0 [14.0-26.6] % vs 25.4 [18.0–35.0] %, p = 0.023). A positive linear correlation was found between BMI and EIT-derived best PEEP (Spearman R = 0.46, p < 0.001). For detecting the optimal PEEP ≥ 12 cmH2O, a cutoff of BMI > 30 kg/m² would provide a specificity of 96.4% and a positive predictive value of 88.2%. Conclusion A lower PEEP resulted in more collapse and a higher PEEP resulted in less overdistension in obese ARDS patients. The findings provided evidence to consider BMI in setting PEEP for this patient group.

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Multicentre, parallel, open-label, two-arm, randomised controlled trial on the prognosis of electrical impedance tomography-guided versus low PEEP/FiO2 table-guided PEEP setting: a trial protocol

Cited by 2 publications

References 42 publications

Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions

Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions

The influence of BMI on optimal PEEP titrated by electrical impedance tomography in ARDS patients

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