ARDS is a frequent reason for hospitalization in intensive care. In order to improve its management, doctors seek to limit the mechanical ventilation-induced injuries (VILI) that can occur. PEEP is a parameter that plays a role in the appearance of VILI, and its adjustment can be optimized by EIT. The EIT is a non-invasive, non-irradiating, real-time monitoring device, today widely used for the optimization of ventilation in patients intubated for ARDS. The positioning of the EIT belt at different chest heights could influence the result of the PEEP titration.
Occurrence of moderate to severe ARDS (PaO2/FiO2 ratio ≤ 200 mmHg) within 72 hours following intubation
Criteria for moderate to severe ARDS for less than 72 hours
Passive ventilation in controlled assisted ventilation (no spontaneous ventilation)
Consent of next of kin
Age < 18 years
ECMO
Pneumothorax
Pacemaker or implantable defibrillator
Single group
EIT
DeviceTwo PEEP titrations monitored by EIT will be performed, each with the electrode belt positioned at a different chest height (2nd intercostal space or 5th intercostal space). The order will be drawn at random.
Impact of the position of the electrode belt on the results of PEEP titration by EIT.
Optimal PEEP determined by PEEP titration using the crossing point method.
Impact of the existence of intra-tidal recruitment on the discordance between PEPEIT and PEPCRS
Variability of the impedance variation during insufflation of the tidal volume ("tidal impedance variation) during titration measured by the relative interquartile coefficient (Q3-Q1)/median
Factors associated with a discordance between PEPEIT and PEPCRS
Variability of the impedance variation during insufflation of the tidal volume ("tidal impedance variation) during titration measured by the relative interquartile coefficient (Q3-Q1)/median
Discrepancy between compliance measured according to impedance and compliance measured according to exhaled volume
Regional ventilation delay (RVD)
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