Study of PEEP Settings Guided by Electrical Impedance Tomography Versus Standard FiO2-PEEP Table in Adults with Moderate to Severe ARDS on Mechanical Ventilation

What this Trial Is About

This research aims to compare two methods of setting positive end-expiratory pressure PEEP in adults with moderate to severe acute respiratory distress syndrome ARDS who require mechanical ventilation. ARDS is linked to high mortality, and while mechanical ventilation is essential, it can cause lung injury. The study focuses on whether using electrical impedance tomography EIT to guide PEEP settings improves blood oxygenation and lung function compared to the traditional low FiO2-PEEP table approach. Participants will be randomly assigned to one of two groups. The intervention group will have PEEP adjusted using EIT guidance with a stepwise decremental PEEP trial, which involves increasing and then gradually decreasing PEEP while monitoring lung overdistension and collapse. The control group will have PEEP set according to the low FiO2-PEEP table based on standard ARDSnet protocol. Both groups will receive lung-protective ventilation with sedation and neuromuscular blockade to synchronize with the ventilator. Throughout the study, researchers will monitor blood oxygen levels and lung mechanics daily for seven days. Additional assessments include ventilator-free days, length of intensive care unit stay, mechanical ventilation duration, complications such as pneumothorax, rescue therapy use, organ failure scores, and mortality up to two months. Patient safety is closely observed during PEEP adjustments, with criteria to stop procedures if significant blood pressure or oxygen drops occur. The study duration for each participant includes these daily assessments over a week and follow-up for two months.

The Impact of PEEP-guided Electrical Impedance Tomography on Oxygenation and Pulmonary Mechanics in Moderate-to-severe ARDS