Tương quan và khác biệt giữa PEEP theo cắt lớp phổi điện kháng và PEEP giả định theo bảng PEEP thấp/FiO2 trong ARDS ngoại khoa

Abstract

PEEP selection in ARDS requires a balance between alveolar recruitment and avoidance of overdistension. This prospective method-comparison study included 42 patients with trauma-related or postoperative ARDS and aimed to evaluate the correlation and agreement between electrical impedance tomography-derived PEEP recommendation (PEEP_EIT) and hypothetical PEEP derived from the ARDS Network low PEEP/FiO₂ table (PEEP_table). Each patient contributed one paired value after the first EIT-guided PEEP titration. PEEP_EIT was determined at the balance point between alveolar collapse and overdistension; PEEP_table was inferred from the corresponding FiO₂. Analyses included the Wilcoxon signed-rank test, Pearson, Spearman correlation, and Bland–Altman analysis. Median PEEP_EIT was 9.0 (8.0 – 11.0) cmH₂O; median PEEP_table was 10.0 (8.0 – 10.0) cmH₂O; p = 0.198. Bland–Altman analysis showed a mean bias of 0.69 cmH₂O, with 95% limits of agreement from -5.16 to 6.54 cmH₂O. An absolute difference ≥ 4 cmH₂O was observed in 26.2% of patients. PEEP_EIT and PEEP_table showed weak correlation and clinically relevant individual-level differences. These two values should not be considered directly interchangeable.