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

Abstract

Objective: To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients.

Design: A systematic review and meta-analysis.

Setting: 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed.

Participants: Randomized clinical trials patients with ARDS.

Main variables: PaO₂/FiO₂-ratio and respiratory system compliance.

Intervension: The quality of the studies was assessed with the Cochrane risk and bias tool.

Results: 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO₂/FiO₂ ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364-0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD -0.085, (95% CI -0.342 to 0.172)].

Conclusions: The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo-controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS.

Keywords: Acute Respiratory Distress Syndrome; Electrical Impedance Tomography; Meta-analysis; Metaanálisis; Positive End-Expiratory Pressure; Presión espiratoria final positiva; Síndrome de distrés respiratorio agudo; Tomografía de impedancia eléctrica.