PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis

Objective: To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients.Design: A systematic review and meta-analysis.Setting: 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed. Participants: Randomized clinical trials patients with ARDS. Main variables: PaO2/FiO2-ratio and respiratory system compliance. Intervension: The quality of the studies was assessed with the Cochrane risk and bias tool.Results: 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO2/FiO2 ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364-0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD -0.085, (95% CI -0.342 to 0.172)].Conclusions: The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS.& COPY; 2022 Published by Elsevier Espan & SIM;a, S.L.U.