PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis

Yu, Mengnan; Deng, Yulin; Cha, Jun; Jiang, Lingyan; Wang, Mingdeng; Qiao, Shigang; Wang, Chen

doi:10.1016/j.medin.2022.06.009

Cited by 5 publications

(1 citation statement)

References 27 publications

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“…Our meta-analysis distinguishes itself from the study conducted by Yu M et al [ 61 ], through several key differences. Specifically, we opted to exclude four studies that were encompassed in the prior meta-analysis for specific reasons: (1) Weber [ 30 ]—this study was omitted because it concentrated on patients undergoing general anesthesia for otorhinolaryngeal surgery.…”

Section: Discussionmentioning

confidence: 92%

Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis

Songsangvorn,

Xu,

et al. 2024

Intensive Care Med

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Purpose Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods. Methods We carried out a systematic review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO 2 /FiO 2 ratio, mortality, stays in intensive care unit (ICU), ventilator-free days). Results EIT-guided PEEP significantly improved lung compliance ( n = 941 cases, mean difference (MD) = 4.33, 95% confidence interval (CI) [2.94, 5.71]), reduced mechanical power ( n = 148, MD = − 1.99, 95% CI [− 3.51, − 0.47]), and lowered driving pressure ( n = 903, MD = − 1.20, 95% CI [− 2.33, − 0.07]) compared to traditional methods. Sensitivity analysis showed consistent positive effect 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 a trend towards improvement. A reduction in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) was associated with modest improvements in compliance and driving pressure in three studies. Conclusions EIT facilitates real-time, individualized PEEP adjustments, improving respiratory system mechanics. Integration of EIT as a guiding tool in mechanical ventilation holds potential benefits in preventing ventilator-induced lung injury. Larger-scale studies are essential to validate and optimize EIT’s clinical utility in ARDS management. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07362-2.

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Section: Discussionmentioning

confidence: 92%