Individualized PEEP titration guided by intratidal compliance profile analysis improves regional ventilation – a randomized controlled trial

Background Application of positive end-expiratory pressure (PEEP) improves lung aeration and reduces mechanical stress during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy to titrate optimal PEEP. By analyzing the intratidal compliance profiles, PEEP may be titrated patient-individually. Methods After obtaining informed consent, we measured respiratory system mechanics and regional ventilation in 60 consecutive patients undergoing elective surgery, randomly allocated to the control group (PEEP = 5 cmH 2 O) or the intervention group receiving individually titrated PEEP, guided by intratidal compliance profile analysis. Primary endpoint was the nonlinear intratidal compliance. We further investigated respiratory and hemodynamic variables, regional ventilation and compliance profiles. Results Compliance was comparable between control [63.2 (14.0) mL·cmH 2 O -1 ] and intervention group [67.8 (15.9) mL·cmH 2 O -1 , p = 0.271]. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH 2 O] respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. Relative thoracic electrical impedance was better maintained in the intervention group (89.3 (19.4) %) than in the control group (78.3 (23.6) %, p < 0.001). No significant differences in dorsal to ventral ventilation distribution was found between the two groups. Conclusions Individualized PEEP titration according to bedside compliance profile analysis improves regional ventilation without affecting respiratory and hemodynamic variables negatively and may be a promising approach to patient-individual ventilation setting.