Electrical impedance tomography for PEEP titration in ARDS patients: a systematic review and meta-analysis.
Summary
This PRISMA-compliant meta-analysis (4 studies; n=271) found that EIT-guided PEEP titration was associated with reduced mortality in ARDS (RR 0.64, 95% CI 0.45–0.91), with no significant differences in other outcomes. Evidence is limited by small, single-center studies and potential selective reporting.
Key Findings
- EIT-guided PEEP titration reduced mortality in ARDS (RR 0.64; 95% CI 0.45–0.91).
- No significant differences were observed in MV days, ICU LOS, weaning success, barotrauma, driving pressure, mechanical power, or SOFA score.
- Included 3 RCTs and 1 controlled observational study; all single-center (total n=271).
Clinical Implications
EIT-guided PEEP titration may be considered to personalize ventilation in ARDS, but widespread adoption should await multicenter RCTs and standardized protocols.
Why It Matters
Provides pooled clinical evidence that a bedside imaging tool can guide ventilator settings to improve survival in ARDS, potentially informing protocolized PEEP titration.
Limitations
- All studies were single-center and small, limiting generalizability
- Potential selective outcome reporting and heterogeneity in EIT protocols
Future Directions
Conduct adequately powered multicenter RCTs with standardized EIT protocols, core outcome sets, and cost-effectiveness analyses.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Systematic review and meta-analysis including randomized controlled trials
- Study Design
- OTHER