Clinical analysis of electrical impedance tomography-guided PEEP titration in the treatment of patients with ARDS

doi:10.3877/cma.j.issn.1674-6902.2025.06.019

Abstract

Abstract:

Objective

To analyze the clinical efficacy of electrical impedance tomography (EIT)-guided titration of positive end-expiratory pressure (PEEP) in the treatment of patients with acute respiratory distress syndrome (ARDS).

Methods

A total of 69 ARDS patients admitted to our hospital from March 2023 to April 2025 were selected and divided into a control group 36 cases and an observation group 33 cases using a random number table. The control group received PEEP selection based on the PEEP-fraction of inspired oxygen (FiO₂) strategy, while the observation group received EIT-guided PEEP titration. The two groups were compared in terms of pulmonary function indicators [pulmonary vascular resistance index (PVRI), extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI)], respiratory mechanics parameters [peak airway pressure (Ppeak), compliance of the respiratory system (Crs), plateau airway pressure (Pplat), oxygenation index (PaO₂/FiO₂)], disease-related scores [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), lung ultrasound (LUS), sequential organ failure assessment (SOFA)], gas distribution, and treatment efficacy.

Results

After treatment, the observation group had significantly lower EVLWI[(5.85±0.91) ml/kg], PVRI[(2.61±0.44) WU], and PVPI[(1.54±0.21)] than the control group[(6.48±1.13) ml/kg, (2.85±0.46) WU, (1.72±0.28), respectively] (P<0.05). In terms of respiratory mechanics parameters, the observation group had lower Ppeak[(25.93±4.27) cmH₂O] and Pplat[(22.17±3.53) cmH₂O] than the control group [(28.49±4.16) cmH₂O, (24.58±3.94) cmH₂O, respectively], while higher Crs[(36.78±5.14) ml/cmH₂O] and PaO₂/FiO₂[(203.25±31.58) mmHg] than the control group[(34.27±5.08) ml/cmH₂O, (185.63±27.82) mmHg, respectively] (P<0.05). The observation group also had lower APACHE Ⅱ score [(14.43±2.68) points], LUS score[(14.35±2.57) points], and SOFA score [(6.29±1.35) points] compared with the control group [(16.28±2.75) points, (15.92±2.78) points, (7.12±1.57) points, respectively] (P<0.05). At 24 hours after treatment, the observation group showed significantly higher percentages of region of interest (ROI) 1 [(12.07±1.63)%], ROI 3[(34.63±3.76)%], and ROI 4[(11.31±1.63)%] than the control group[(11.28±1.57)%, (32.62±4.31)%, (10.52±1.58)%, respectively], and a lower percentage of ROI 2[(42.18±4.85)%] than the control group[(45.59±5.69)%] (P<0.05). The duration of mechanical ventilation[(5.17±0.94) days] and length of stay in the intensive care unit (ICU)[(8.28±1.42) days] in the observation group were significantly shorter than those in the control group[(5.69±0.78) days, (9.03±1.56) days, respectively] (P<0.05). However, there were no significant differences in in-hospital mortality(12.12% vs. 25.00%) between the two groups (P>0.05).

Conclusion

The application of EIT technology to guide PEEP therapy helps shorten the duration of mechanical ventilation and ICU stay, and improves respiratory mechanics parameters and pulmonary gas distribution.

Key words: Acute respiratory distress syndrome, Pulmonary function, Electrical impedance tomography, Positive end-expiratory pressure

Yawen Liu, Yanhu Sun, Xiaohan Xu, Yue Li, Xudong Wang. Clinical analysis of electrical impedance tomography-guided PEEP titration in the treatment of patients with ARDS[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 966-972.

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References 35

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组　别	例数	EVLWI(ml/kg)		PVRI(WU)		PVPI
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	11.24±2.07	5.85±0.91^a	5.47±0.82	2.61±0.44^a	3.39±0.58	1.54±0.21^a
对照组	36	10.79±1.85	6.48±1.13^a	5.63±0.89	2.85±0.46^a	3.57±0.62	1.72±0.28^a
t值		0.954	2.536	0.774	2.210	1.242	2.999
P值		0.344	0.014	0.441	0.031	0.219	0.004

组　别	例数	EVLWI(ml/kg)		PVRI(WU)		PVPI
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	11.24±2.07	5.85±0.91^a	5.47±0.82	2.61±0.44^a	3.39±0.58	1.54±0.21^a
对照组	36	10.79±1.85	6.48±1.13^a	5.63±0.89	2.85±0.46^a	3.57±0.62	1.72±0.28^a
t值		0.954	2.536	0.774	2.210	1.242	2.999
P值		0.344	0.014	0.441	0.031	0.219	0.004

组　别	例数	Ppeak(cmH₂O)		Pplat(cmH₂O)		Crs(ml/cmH₂O)		PaO₂/FiO₂(mmHg)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	34.28±5.64	25.93±4.27^a	27.65±4.08	22.17±3.53^a	32.07±4.92	36.78±5.14^a	145.82±20.76	203.25±31.58^a
对照组	36	34.75±5.92	28.49±4.16^a	27.26±3.87	24.58±3.94^a	31.84±4.59	34.27±5.08^a	147.39±21.65	185.63±27.82^a
t值		0.337	3.506	0.407	2.667	0.201	2.039	0.307	2.464
P值		0.737	0.000	0.685	0.010	0.841	0.045	0.760	0.016

组　别	例数	Ppeak(cmH₂O)		Pplat(cmH₂O)		Crs(ml/cmH₂O)		PaO₂/FiO₂(mmHg)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	34.28±5.64	25.93±4.27^a	27.65±4.08	22.17±3.53^a	32.07±4.92	36.78±5.14^a	145.82±20.76	203.25±31.58^a
对照组	36	34.75±5.92	28.49±4.16^a	27.26±3.87	24.58±3.94^a	31.84±4.59	34.27±5.08^a	147.39±21.65	185.63±27.82^a
t值		0.337	3.506	0.407	2.667	0.201	2.039	0.307	2.464
P值		0.737	0.000	0.685	0.010	0.841	0.045	0.760	0.016

组　别	例数	APACHEⅡ评分(分)		LUS评分(分)		SOFA评分(分)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	23.71±4.23	14.43±2.68^a	17.84±3.12	14.35±2.57^a	9.16±1.76	6.29±1.35^a
对照组	36	23.54±4.19	16.28±2.75^a	18.09±3.26	15.92±2.78^a	8.95±1.63	7.12±1.57^a
t值		0.168	2.826	0.325	2.429	0.515	2.344
P值		0.867	0.006	0.746	0.018	0.609	0.022

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