Abstract Background Several approaches for setting PEEP in patients with (COVID-19-related) ARDS have been proposed. It is unclear whether a best approach exist, and how the recommended PEEP and resulting transpulmonary pressure, overdistension and collapse relate. Objectives To compare approaches based on electrical impedance tomography (EIT) (including targeting the crossing point of overdistension/collapse curves, EIT CP ) with targeting positive end-expiratory transpulmonary pressure (P L,EE ) and targeting highest respiratory system compliance (C RS ). Methods Post-hoc analysis of 29 patients with COVID-19-related ARDS from cohorts of two Dutch hospitals. Patients underwent a decremental PEEP trial, while EIT data and esophageal pressure data were recorded. We compared the recommended PEEP, as well as resulting P L,EE and amounts of overdistension and collapse at the suggested PEEP. Results Targeting EIT CP resulted in higher recommended PEEP (14 12–16 cmH 2 O) compared to a positive P L,EE (12 8–14 cmH 2 O), while highest C RS resulted in intermediate PEEP levels. Individually, the difference between the highest and lowest recommended PEEP level were 6 4–8 cmH 2 O. P L,EE at the recommended PEEP was generally higher when targeting EIT CP compared to and positive P L,EE (1.4 0.6–2.1 cmH 2 O). The amount of collapse was lowest with EIT CP (3.0 2.0–4.0%) and highest when targeting P L,EE (5.4 2.0–12.0%). No significant differences in the amount of overdistension were found. Targeting positive P L,EE resulted in 51% patients with high (> 10%) values for either overdistension or collapse, more than any other method. Conclusions Targeting EIT CP results in slightly higher recommended PEEP and P L,EE levels compared to positive P L,EE , leading to less collapse, but not more overdistension. EIT-based methods protect better against high values of either overdistension or collapse.
Weller et al. (Mon,) studied this question.