The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial

Dinh Van Trung^{1

2}, Bui Thi Huong Giang^{1

3}, Dang Quoc Tuan^{1

3}, Nguyen Cong Tan^{1

3

4}, Pham The Thach^{1

3

4}, Bui Van Cuong^{1

3

4

5}, Nguyen Ba Cuong³, Trinh The Anh³, Nguyen Tu Anh^{1

3}, Nguyen Van Huy^{1

3}, Ho Duc Trieu^{3

4}, Nguyen Van Trong^{3

4}, Tran Thu Trang³, Vuong Xuan Toan³, Nguyen Hoang Nam³, Nguyen Thi Sam³, Truong Mau Thanh³, Nguyen Tien Dat³, Nghiem Thi Phuong Hong³, Pham Thi Hong Phuong³, Dang Duy Hien³, Do Van Hoi³, Hoang Tuan Phong³, Nguyen Dang Thu⁶, Nguyen Thao Trang³, Ngo Xuan Hieu³, Hoang Tien Dat³, Dao Xuan Phuong³, Do Ngoc Son^{7

8

9}

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.
² Phu Tho Provincial General Hospital, Nguyen Tat Thanh Street, Viet Tri Ward, Phu Tho, 35100, Vietnam.
³ Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.
⁴ Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
⁵ Department of Intensive Care for Tropical Diseases, Bach Mai Hospital, Bach Mai Institute for Tropical Medicine, Hanoi, Vietnam.
⁶ Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, No.261 Phung Hung Street, Ha Dong Ward, Hanoi, 12108, Vietnam.
⁷ 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.
⁸ Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam. sonngocdo@gmail.com.
⁹ Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. sonngocdo@gmail.com.

PMID: 41318662
DOI: 10.1038/s41598-025-29787-5

Free article

The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial

Dinh Van Trung et al. Sci Rep. 2025.

Free article

. 2025 Nov 29.

doi: 10.1038/s41598-025-29787-5. Online ahead of print.

Authors

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.
² Phu Tho Provincial General Hospital, Nguyen Tat Thanh Street, Viet Tri Ward, Phu Tho, 35100, Vietnam.
³ Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam.
⁴ Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
⁵ Department of Intensive Care for Tropical Diseases, Bach Mai Hospital, Bach Mai Institute for Tropical Medicine, Hanoi, Vietnam.
⁶ Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, No.261 Phung Hung Street, Ha Dong Ward, Hanoi, 12108, Vietnam.
⁷ 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.
⁸ Center for Critical Care Medicine, Bach Mai Hospital, No. 78 Giai Phong Street, Kim Lien Ward, Hanoi, Vietnam. sonngocdo@gmail.com.
⁹ Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. sonngocdo@gmail.com.

PMID: 41318662
DOI: 10.1038/s41598-025-29787-5

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 < 0.001) and day 2 (15 vs. 17 cmH₂O; p = 0.005). SOFA scores improved more in the EIT group (day 1: - 1 vs. 0, p = 0.013; day 2: - 1 vs. - 0.5, p = 0.015). Twenty-eight-day mortality was lower with EIT (29 vs. 44%), although not statistically significant (p = 0.090). ICU stay, ventilation duration, barotrauma, ECMO use, and rescue therapies were similar. Benefits were most pronounced in patients with severe ARDS. EIT-guided PEEP improved oxygenation, lung mechanics, and reduced organ dysfunction in moderate-to-severe ARDS, particularly in severe cases. It showed a trend toward reduced mortality and may serve as a practical bedside tool for lung-protective ventilation. Larger multicenter trials are needed to confirm its clinical benefits.Trial registration: ClinicalTrials, NCT06733168. Registered on 13/12/2024, https://clinicaltrials.gov/study/NCT06733168.

Keywords: ARDS; Electrical impedance tomography; Oxygenation; PEEP; Respiratory mechanics.

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Conflict of interest statement

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

1. Matthay, M. A. et al. Acute respiratory distress syndrome. Nat. Rev. Dis. Primers 5(1), 18 (2019).
1. Bellani, G. et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315(8), 788–800 (2016).
1. Beitler, J. R., Malhotra, A. & Thompson, B. T. Ventilator-induced lung injury. Clin. Chest Med. 37(4), 633–646 (2016).
1. Grotberg, J. C., Reynolds, D. & Kraft, B. D. Management of severe acute respiratory distress syndrome: a primer. Crit. Care 27(1), 289 (2023).
1. Qadir, N. et al. An update on management of adult patients with acute respiratory distress syndrome: an official american thoracic society clinical practice guideline. Am. J. Respir. Crit. Care Med. 209(1), 24–36 (2024).

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The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial

Affiliations

The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Associated data

LinkOut - more resources

Full Text Sources

Medical