Electrical impedance tomography-guided PEEP and mortality of patients with the acute respiratory distress syndrome: The EITVent randomized clinical trial.
Summary
In 190 moderate–severe ARDS patients, EIT-guided PEEP did not reduce 28-day mortality versus a lower PEEP/FiO2 strategy; ventilator-free days and safety outcomes were also similar. A prespecified analysis indicated potential benefit in patients with high lung recruitability, where EIT assigned higher PEEP and was associated with lower mortality.
Key Findings
- Early-terminated multicenter RCT (n=190) showed no difference in 28-day mortality between EIT-guided PEEP and lower PEEP/FiO2 strategies (HR 0.96, p=0.821).
- No significant differences in ventilator-free days or safety outcomes between groups.
- In patients with higher recruitability, EIT-guided PEEP assigned higher PEEP and was associated with reduced mortality (HR 0.49, p=0.024).
Clinical Implications
EIT-guided PEEP should not be adopted routinely for all ARDS. Assessing lung recruitability (e.g., recruitment–inflation ratio) may help identify patients who could benefit from EIT-guided higher PEEP.
Why It Matters
This is a rigorous RCT testing physiologically personalized PEEP titration. The neutral primary outcome informs practice, while subgroup data generate hypotheses for selective application.
Limitations
- Early termination may have led to underpowering to detect clinically meaningful differences.
- Generalizability may be limited to centers with EIT expertise; recruitability assessment was available in a subset.
Future Directions
Conduct adequately powered trials enriched for high recruitability and predefined PEEP targets; integrate recruitability metrics with EIT or alternative imaging for personalized ventilation.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Multicenter randomized controlled trial with prespecified primary outcome.
- Study Design
- OTHER