ArticleCritical care (London, England)2014
Detection of 'best' positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial.
Article in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03719937 (ArtificiaL Increase in chesT Wall Elastance as an alteRnative to PRONE Positioning in Moderate-to-severe ARDS), which is not on this map. Cited by 45 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
ArtificiaL Increase in chesT Wall Elastance as an alteRnative to PRONE Positioning in Moderate-to-severe ARDS: a Physiological Study The ALTERPRONE Study
Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it, 116 citations in OpenAlex.
- Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis.Intensive care medicine · 2024Pooled it
- The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial.Scientific reports · 2025Trial
- Intraoperative titration of positive end-expiratory pressure in urological patients undergoing laparoscopic procedures under lateral position: a randomized controlled trial.BMC anesthesiology · 2025Trial
- Does Lung Compliance Optimization Through PEEP Manipulations Reduce the Incidence of Postoperative Hypoxemia in Laparoscopic Bariatric Surgery? A Randomized Trial.Obesity surgery · 2019Trial
- Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment.Critical care (London, England) · 2018Trial
- EIT-based ventilation phenotypes of left-to-right asymmetry and ventral-to-dorsal center in PEEP titration in ARDS.Respiratory research · 2026Article
- A Novel Mixed Stimulation Pattern for Balanced Pulmonary EIT Imaging Performance.Bioengineering (Basel, Switzerland) · 2026Article
- Refining thresholds and timing in V/Q matching assessment during prone positioning in ARDS.Annals of intensive care · 2025Article
- Innovative use of EIT-guided prone positioning and inhaled nitric oxide therapy for refractory hypoxemia in primary graft dysfunction: a case report.BMC anesthesiology · 2025Article
- The potential risk of ventilator-induced lung injury from five different PEEP titration techniques in ARDS.Frontiers in medicine · 2025Article
- Detection of spontaneous breathing during an apnea test in a patient with suspected brain death using electrical impedance tomography: a case report.BMC pulmonary medicine · 2024Article
- Contribution of electrical impedance tomography to personalize positive end-expiratory pressure under ECCOCritical care (London, England) · 2024Article
- Bedside personalized methods based on electrical impedance tomography or respiratory mechanics to set PEEP in ARDS and recruitment-to-inflation ratio: a physiologic study.Annals of intensive care · 2024Article
- Clinical Applicability of Electrical Impedance Tomography in Patient-Tailored Ventilation: A Narrative Review.Tomography (Ann Arbor, Mich.) · 2023Review
- Flexible Electrodes as a Measuring System of Electrical Impedance Imaging.Materials (Basel, Switzerland) · 2023Article
- Article
- Pulmonary pathophysiology development of COVID-19 assessed by serial Electrical Impedance Tomography in the MaastrICCht cohort.Scientific reports · 2022Observational
- Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study.Journal of clinical monitoring and computing · 2022Observational
- Methods for Determination of Individual PEEP for Intraoperative Mechanical Ventilation Using a Decremental PEEP Trial.Journal of clinical medicine · 2022Article
- Clinical Implications of Determining Individualized Positive End-Expiratory Pressure Using Electrical Impedance Tomography in Post-Cardiac Surgery Patients: A Prospective, Non-Randomized Interventional Study.Journal of clinical medicine · 2022Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis study compares different parameters derived from electrical impedance tomography (EIT) data to define 'best' positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. 'Best' PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury.
methodsA decremental PEEP trial (from 15 to 0 cm H2O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO2/FiO2 ratio.
resultsDynamic compliance and the PaO2/FiO2 ratio had the highest value at 10 and 15 cm H2O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H2O PEEP for the non-dependent lung region and a maximal value at 15 cm H2O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H2O PEEP, whereas for COV and the RVD index this was at 15 cm H2O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient.
conclusionIn post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate 'best' PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome.
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