Methods for Determination of Individual PEEP for Intraoperative Mechanical Ventilation Using a Decremental PEEP Trial

Felix Girrbach; Franziska Zeutzschel; Susann Schulz; Mirko Lange; Alessandro Beda; Antonio Giannella-Neto; Hermann Wrigge; Philipp Simon

doi:10.3390/jcm11133707

Methods for Determination of Individual PEEP for Intraoperative Mechanical Ventilation Using a Decremental PEEP Trial

J Clin Med. 2022 Jun 27;11(13):3707. doi: 10.3390/jcm11133707.

Authors

Felix Girrbach¹, Franziska Zeutzschel^{1

2}, Susann Schulz¹, Mirko Lange¹, Alessandro Beda³, Antonio Giannella-Neto⁴, Hermann Wrigge^{5

6}, Philipp Simon⁷

Affiliations

¹ Department of Anesthesiology and Intensive Care, University of Leipzig Medical Center, 04103 Leipzig, Germany.
² Department of Surgery, Carl-von-Basedow Klinikum Saalekreis, 06217 Merseburg, Germany.
³ Department of Electronic Engineering and Postgraduate Program of Electrical Engineering, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil.
⁴ Programa de Engenharia Biomédica-COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
⁵ Integrated Research and Treatment Centre (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany.
⁶ Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, 06112 Halle, Germany.
⁷ Anesthesiology and Operative Intensive Care, Faculty of Medicine, University of Augsburg, 86161 Augsburg, Germany.

Abstract

(1) Background: Individual PEEP settings (PEEPIND) may improve intraoperative oxygenation and optimize lung mechanics. However, there is uncertainty concerning the optimal procedure to determine PEEPIND. In this secondary analysis of a randomized controlled clinical trial, we compared different methods for PEEPIND determination. (2) Methods: Offline analysis of decremental PEEP trials was performed and PEEPIND was retrospectively determined according to five different methods (EIT-based: RVDI method, Global Inhomogeneity Index [GI], distribution of tidal ventilation [EIT VT]; global dynamic and quasi-static compliance). (3) Results: In the 45 obese and non-obese patients included, PEEPIND using the RVDI method (PEEPRVD) was 16.3 ± 4.5 cm H2O. Determination of PEEPIND using the GI and EIT VT resulted in a mean difference of −2.4 cm H2O (95%CI: −1.2;−3.6 cm H2O, p = 0.01) and −2.3 cm H2O (95% CI: −0.9;3.7 cm H2O, p = 0.01) to PEEPRVD, respectively. PEEPIND selection according to quasi-static compliance showed the highest agreement with PEEPRVD (p = 0.67), with deviations > 4 cm H2O in 3/42 patients. PEEPRVD and PEEPIND according to dynamic compliance also showed a high level of agreement, with deviations > 4 cm H2O in 5/42 patients (p = 0.57). (4) Conclusions: High agreement of PEEPIND determined by the RVDI method and compliance-based methods suggests that, for routine clinical practice, PEEP selection based on best quasi-static or dynamic compliance is favorable.

Keywords: electrical impedance tomography; general anesthesia; mechanical ventilation; positive end-expiratory pressure.

Grants and funding

Part of this trial was funded by the Federal Ministry of Education and Research, Germany (Integrated Research and Treatment Center IFB “Adiposity Diseases”, FKZ: 01E01001), and by departmental funding (University of Leipzig Medical Center, Leipzig, Germany, 925000-066). A.G.N. was partially founded by CAPES, Ministério da Educação do Brasil (Fellowship BEX10876/13-8). H.W. received research funding, lecture fees, and technical support from Dräger Medical, Lübeck, Germany; funding from Pfizer (Investigator Initiated Trial Program), Berlin, Germany; funding and lecture fees from InfectoPharm, Heppenheim, Germany; lecture fees from GE Healthcare, Freiburg, Germany, lecture fees from Maquet, Rastatt, Germany; lecture fees from MSD, Konstanz, Germany; and technical support from Swisstom Corp., Landquart, Switzerland. P.S. received research technical support from Dräger Medical, Lübeck, Germany; funding from Pfizer (Investigator Initiated Trial Program), Berlin, Germany; funding and lecture fees from InfectoPharm, Heppenheim, Germany.