Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
Hong Ren, Li Xie, Zhulin Wang, Xiaoliao Tang, Botao Ning, Teng Teng, Juan Qian, Ying Wang, Lijun Fu, Zhanqi Zhao, Long Xiang
Abstract
Purpose To investigate the difference in the positive end-expiratory pressure (PEEP) selected with chest electrical impedance tomography (EIT) and with global dynamic respiratory system compliance (C rs ) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS). Methods Patients with moderate-to-severe pARDS (PaO 2 /FiO 2 < 200 mmHg) were retrospectively included. On the day of pARDS diagnosis, two PEEP levels were determined during the decremental PEEP titration for each individual using the best compliance (PEEP C ) and EIT-based regional compliance (PEEP EIT ) methods. The differences of global and regional compliance (for both gravity-dependent and non-dependent regions) under the two PEEP conditions were compared. In addition, the EIT-based global inhomogeneity index (GI), the center of ventilation (CoV), and standard deviation of regional delayed ventilation (RVD SD ) were also calculated and compared. Results A total of 12 children with pARDS (5 with severe and 7 with moderate pARDS) were included. PEEP C and PEEP EIT were identical in 6 patients. In others, the differences were only ± 2 cm H 2 O (one PEEP step). There were no statistical differences in global compliance at PEEP C and PEEP EIT [28.7 (2.84–33.15) vs. 29.74 (2.84–33.47) ml/cm H 2 O median (IQR), p = 0.028 (the significant level after adjusted for multiple comparison was 0.017)]. Furthermore, no differences were found in regional compliances and other EIT-based parameters measuring spatial and temporal ventilation distributions. Conclusion Although EIT provided information on ventilation distribution, PEEP selected with the best C rs might be non-inferior to EIT-guided regional ventilation in moderate-to-severe pARDS. Further study with a large sample size is required to confirm the finding.