EIT guided evaluation of regional ventilation distributions in neonatal and pediatric ARDS: a prospective feasibility study.
Summary
In 26 neonatal/pediatric ARDS or PLD patients (40 EIT measurements), EIT-guided PEEP was feasible and tended to be lower than both clinician-set and ARDSnet-recommended PEEP. EIT-guided individualized PEEP may optimize regional ventilation and potentially reduce VILI, including during ECMO.
Key Findings
- EIT-guided PEEP determination was feasible and safe in 26 neonatal/pediatric patients (40 measurements), including during ECMO.
- Median EIT-derived PEEP (11 mbar) was lower than clinician-set PEEP (11.5 mbar, p<0.001) and ARDSnet-recommended PEEP (14 mbar, p=0.018).
- In nARDS/PLD, EIT-PEEP was 3 mbar below clinician-set and 11 mbar below ARDSnet recommendations.
Clinical Implications
Consider EIT-guided PEEP titration in pediatric ARDS to balance overdistension and collapse at the bedside, potentially lowering PEEP compared with ARDSnet tables and clinician defaults, even during ECMO.
Why It Matters
Provides prospective evidence supporting bedside EIT to individualize PEEP in neonatal/pediatric ARDS, a population lacking robust monitoring tools.
Limitations
- Single-center feasibility study with small sample size
- Retrospective trial registration and no clinical outcome endpoints powered for efficacy
Future Directions
Multi-center randomized or adaptive trials testing EIT-guided PEEP against standard care in pediatric ARDS with VILI and outcome endpoints.
Study Information
- Study Type
- Cohort
- Research Domain
- Diagnosis
- Evidence Level
- II - Prospective feasibility cohort evaluating EIT-guided PEEP titration
- Study Design
- OTHER