Acute respiratory distress syndrome (ARDS) remains a serious and often fatal complication in patients following severe trauma or major surgery. Mechanical ventilation is essential for supportive care in this population, but may aggravate lung injury when suboptimal ventilatory settings are applied. Positive end-expiratory pressure (PEEP) is crucial for maintaining alveolar recruitment; however, optimal PEEP selection in trauma- or postoperative-associated ARDS remains uncertain. Electrical impedance tomography (EIT) enables bedside, real-time assessment of regional ventilation and may support optimal PEEP titration by balancing alveolar overdistension and collapse. This study compares EIT-guided PEEP optimization with the conventional low FiO₂-PEEP strategy in terms of oxygenation and respiratory mechanics in patients with moderate to severe ARDS following trauma or surgery.
Mechanically ventilated surgical intensive care patients with trauma- or postoperative-associated moderate to severe ARDS, as defined by the 2023 Global Definition of ARDS.
Age <18 or >90 years.
Severe acute brain injury or acute stroke with Glasgow Coma Scale <8.
Thoracic trauma with pneumothorax or pneumomediastinum.
End-stage diseases under palliative care (e.g., metastatic cancer, cirrhosis, end-stage renal disease).
Parallel
EIT-giuded PEEP
DeviceDevice: electrical impedance tomography system (Enlight 2100, Timpel SA, Brazil). \- Patients underwent airway suctioning and were deeply sedated (RASS ≤ -3) to abolish spontaneous breathing. PEEP titration was performed using an EIT system (Enlight 2100, Timpel SA, Brazil), with a silicone belt containing 32 surface electrodes positioned at the fourth to fifth intercostal space in accordance with the manufacturer's instructions. Pressure-controlled ventilation was applied with an inspiration pressure set at 15 cmH₂O and a set PEEP of 24 cmH₂O, with a maximum airway pressure limit of 40 cmH₂O. Ventilator settings were maintained for 30 seconds with an FiO₂ of 1.0. A decremental PEEP trial was then performed by reducing PEEP in 2 cmH₂O every 30 seconds until a PEEP of 6 cmH₂O was reached or the SpO₂ decreased to ≤ 80%. The EIT-guided optimal PEEP was defined as the PEEP level corresponding to the intersection point of the collapse and overdistension curves.
Control
DevicePEEP was set and adjusted according to the lower PEEP/FiO₂ table of the ARDS Network
Oxygenation
PaO₂/FiO₂ ratio
Pulmonary Mechanics
Static Compliance
Ventilator free days
Ventilator free days
Length of ICU stay
Days of ICU stay
Length of mechanical ventilated days
Days of received mechanical ventilation
Barotrauma
pneumothorax, pneumomediastinum, and subcutaneous emphysema
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Nguyen Dang Thu
Lead sponsor
Vietnam Military Medical University
Sponsor institution
Hanoi Medical University
Collaborator
Viet Duc University Hospital
Collaborator
