The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial.
| Title: | The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial. |
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| Authors: | Van Trung D; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Phu Tho Provincial General Hospital, Nguyen Tat Thanh Street, Viet Tri Ward, Phu Tho, 35100, Vietnam.; Giang BTH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Tuan DQ; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Tan NC; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Thach PT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Van Cuong B; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Department of Intensive Care for Tropical Diseases, Bach Mai Hospital, Bach Mai Institute for Tropical Medicine, Hanoi, Vietnam.; Cuong NB; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Anh TT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Anh NT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Van Huy N; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Trieu HD; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Van Trong N; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Trang TT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Toan VX; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Nam NH; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Sam NT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Thanh TM; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Dat NT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Hong NTP; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Phuong PTH; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Hien DD; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Van Hoi D; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Phong HT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Thu ND; Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, No.261 Phung Hung Street, Ha Dong Ward, Hanoi, 12108, Vietnam.; Trang NT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Hieu NX; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Dat HT; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Phuong DX; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.; Son DN; Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam. sonngocdo@gmail.com.; Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam. sonngocdo@gmail.com.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. sonngocdo@gmail.com. |
| Source: | Scientific reports [Sci Rep] 2025 Nov 29; Vol. 16 (1), pp. 391. Date of Electronic Publication: 2025 Nov 29. |
| Publication Type: | Journal Article; Randomized Controlled Trial |
| Language: | English |
| Journal Info: | Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : Nature Publishing Group, copyright 2011- |
| MeSH Terms: | Respiratory Distress Syndrome*/therapy ; Respiratory Distress Syndrome*/physiopathology ; Respiratory Distress Syndrome*/mortality ; Respiratory Distress Syndrome*/diagnostic imaging ; Positive-Pressure Respiration*/methods ; Tomography*/methods ; Oxygen*/metabolism ; Respiratory Mechanics*; Ventilator-Induced Lung Injury/prevention & control ; Humans ; Male ; Female ; Middle Aged ; Electric Impedance ; Aged ; Adult ; Treatment Outcome |
| Abstract: | Electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration may optimize ventilation and reduce ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). We compared EIT-guided PEEP with low PEEP/FiO₂ strategy in patients with moderate-to-severe ARDS. In this randomized controlled trial, 108 patients with PaO₂/FiO₂ below 200 mmHg were allocated to EIT-guided PEEP after a recruitment maneuver (n = 56) or low PEEP/FiO₂ strategy (n = 52). Patients in the EIT group underwent PEEP titration guided by the intersection point between alveolar overdistension and collapse during a decremental PEEP trial. Primary outcomes were oxygenation (PaO₂/FiO₂) and static compliance. Secondary outcomes included mortality, ventilator-free days, ICU stay, barotrauma, rescue therapies, and sequential organ failure assessment (SOFA) score changes. On day 1, oxygenation was higher with EIT (mean PaO₂/FiO₂ 180 vs. 159 mmHg; p = 0.036). Static compliance was greater at both day 1 (26 vs. 23 mL/cmH₂O; p = 0.016) and day 2 (27 vs. 24 mL/cmH₂O; p = 0.029). Driving pressure was lower with EIT at day 1 (16 vs. 17 cmH₂O; p |
| Competing Interests: | Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study was approved by the Bach Mai Hospital Ethics Committee, Vietnam (Approval Number: 5532/BM-HDDD). Written informed consent was obtained from all participants. The trial was conducted in accordance with the Declaration of Helsinki and reported following the CONSORT guidelines. |
| References: | Sci Rep. 2022 Dec 15;12(1):21687. (PMID: 36522433); Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36. (PMID: 38032683); JAMA. 2016 Feb 23;315(8):788-800. (PMID: 26903337); Crit Care. 2014 May 10;18(3):R95. (PMID: 24887391); Intensive Care Med. 2023 Jul;49(7):727-759. (PMID: 37326646); Sci Rep. 2024 Apr 27;14(1):9669. (PMID: 38671072); Am J Respir Crit Care Med. 2023 Jul 1;208(1):25-38. (PMID: 37097986); J Intensive Care. 2022 Jul 8;10(1):32. (PMID: 35799288); Nat Commun. 2025 Jan 13;16(1):622. (PMID: 39805822); Sci Rep. 2022 Jun 4;12(1):9331. (PMID: 35660756); Crit Care. 2018 Oct 25;22(1):263. (PMID: 30360753); JAMA. 2008 Feb 13;299(6):637-45. (PMID: 18270352); Crit Care. 2021 Jun 30;25(1):230. (PMID: 34193224); N Engl J Med. 2000 May 4;342(18):1301-8. (PMID: 10793162); Am J Respir Crit Care Med. 2017 Jun 1;195(11):1429-1438. (PMID: 28146639); JAMA. 2010 Mar 3;303(9):865-73. (PMID: 20197533); Crit Care Explor. 2021 Jul 13;3(7):e0486. (PMID: 34278316); Clin Chest Med. 2016 Dec;37(4):633-646. (PMID: 27842744); Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47. (PMID: 37487152); N Engl J Med. 2006 Apr 27;354(17):1775-86. (PMID: 16641394); J Intensive Care. 2019 Jan 18;7:4. (PMID: 30680219); Crit Care. 2023 Jul 18;27(1):289. (PMID: 37464381); Intensive Care Med. 2024 Jul;50(7):1143-1145. (PMID: 38656359); Sci Rep. 2025 Mar 03;15(1):7406. (PMID: 40033012); Crit Care. 2022 Sep 12;26(1):272. (PMID: 36096837); Crit Care. 2020 Sep 1;24(1):540. (PMID: 32873337); JAMA. 2017 Oct 10;318(14):1335-1345. (PMID: 28973363); Curr Opin Crit Care. 2014 Jun;20(3):323-32. (PMID: 24739268); J Intensive Care. 2023 Sep 25;11(1):41. (PMID: 37749637); Crit Care. 2023 Jan 17;27(1):21. (PMID: 36650593); N Engl J Med. 2015 Feb 19;372(8):747-55. (PMID: 25693014); Nat Rev Dis Primers. 2019 Mar 14;5(1):18. (PMID: 30872586); Crit Care Med. 2017 May;45(5):843-850. (PMID: 28252536); Am J Respir Crit Care Med. 2020 Jan 15;201(2):178-187. (PMID: 31577153); Sci Rep. 2023 Feb 16;13(1):2753. (PMID: 36797394); Ann Intensive Care. 2019 Jan 17;9(1):7. (PMID: 30656479) |
| Contributed Indexing: | Keywords: ARDS; Electrical impedance tomography; Oxygenation; PEEP; Respiratory mechanics |
| Molecular Sequence: | ClinicalTrials.gov NCT06733168 |
| Substance Nomenclature: | S88TT14065 (Oxygen) |
| Entry Date(s): | Date Created: 20251129 Date Completed: 20260106 Latest Revision: 20260112 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12770395 |
| DOI: | 10.1038/s41598-025-29787-5 |
| PMID: | 41318662 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial