The potential risk of ventilator-induced lung injury from five different PEEP titration techniques in ARDS
1
Issued Date
2025-01-01
Resource Type
eISSN
2296858X
Scopus ID
2-s2.0-105015520904
Journal Title
Frontiers in Medicine
Volume
12
Rights Holder(s)
SCOPUS
Bibliographic Citation
Frontiers in Medicine Vol.12 (2025)
Suggested Citation
Sutherasan Y., Songsomboon C., Gulapa K., Junhasavasdikul D., Theerawit P. The potential risk of ventilator-induced lung injury from five different PEEP titration techniques in ARDS. Frontiers in Medicine Vol.12 (2025). doi:10.3389/fmed.2025.1642064 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112082
Title
The potential risk of ventilator-induced lung injury from five different PEEP titration techniques in ARDS
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Abstract
Introduction: The optimal positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remains uncertain. This study compared the PEEP levels using five distinct titration methods to assess potential ventilator-induced lung injury (VILI). Methods: This study included 21 patients with moderate to severe ARDS who were monitored using esophageal balloon manometry and electrical impedance tomography (EIT). A recruitment maneuver followed by decremental PEEP titration was performed. Optimal PEEP (OP) was assessed using five criteria: highest respiratory system compliance (C<inf>RS</inf>), highest lung compliance (C<inf>L</inf>), end-expiratory transpulmonary pressure (P<inf>tp_ee_direct</inf>) ≥ 0 cm H<inf>2</inf>O, elastance-derived end-inspiratory transpulmonary pressure (P<inf>tp_ei_derived</inf>) ≤ 25 cm H<inf>2</inf>O, and EIT-based analysis balancing the degree of overdistention and lung collapse. Results: Significant differences in OP were observed across the methods (p = 0.001): C<inf>RS</inf> 8.0 cmH₂O (8.0,13.9); C<inf>L</inf> 9.8 cmH₂O (8.0,14.0); P<inf>tp_ee_direct</inf> ≥ 0 cmH₂O 14.0 cm H₂O (11.9,17.9); P<inf>tp_ei_derived</inf> ≤ 25 cmH₂O 12.0 cmH₂O (10.0,13.9); EIT balancing the degree of overdistention and lung collapse 13.01 cmH₂O (9.88,14.78). The OP guided by P<inf>tp_ee_direct</inf> of ≥ 0 cm H<inf>2</inf>O is significantly higher than OP by the highest C<inf>RS</inf> (p = 0.001) and the highest C<inf>L</inf> (p = 0.002), and met the overdistension criteria, namely plateau pressure > 30 cm H<inf>2</inf>O and the highest percentage of overdistension by EIT. The PEEP guided by C<inf>RS</inf> had a higher potential risk of lung collapse, reflected by the negative value of P<inf>tp_ee_direct</inf> and a higher percentage of lung collapse by EIT. Conclusion: Transpulmonary pressure-guided PEEP titration yielded higher PEEP levels, while C<inf>RS</inf>-guided PEEP was lower and associated with a higher risk of collapse. Overdistension and collapse varied with the chosen PEEP method. In patients with moderate to severe ARDS, OP can vary depending on the method of assessment.