ArticleCritical care (London, England)2023
Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 26 citations in OpenAlex.
- Association between driving pressure and recruitment-to-inflation ratio in personalized PEEP management at the bedside.Scientific reports · 2026Observational
- Ventilator-induced lung injury: from mechanisms to integrated clinical management.Frontiers in medicine · 2026Review
- Impact of PEEP on V/Q mismatch according to patient position and recruitability: a clinical prospective study.Annals of intensive care · 2026Article
- Predicting early prone position ventilation responsiveness in patients with acute respiratory distress syndrome based on electrical impedance tomography: a prospective study.Critical care (London, England) · 2025Observational
- Recommendations for lung ventilation and perfusion assessment with chest electrical impedance tomography in critically ill adult patients: an international evidence-based and expert Delphi consensus study.EClinicalMedicine · 2025Article
- Lung electrical impedance tomography during positioning, weaning and chest physiotherapy in mechanically ventilated critically ill patients: a narrative review.Annals of intensive care · 2025Review
- Imaging and pulmonary function techniques in ARDS diagnosis and management: current insights and challenges.Critical care (London, England) · 2025Review
- Real-time stress and strain monitoring at the bedside: new frontiers in mechanical ventilation.Frontiers in medicine · 2025Review
- Determination of positive end-expiratory pressure in COVID-19-related acute respiratory distress syndrome: A systematic review.European journal of anaesthesiology and intensive care · 2024Article
- Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions.Critical care (London, England) · 2024Review
- Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study.Annals of intensive care · 2024Article
- Respiratory Support Effects over Time on Regional Lung Ventilation Assessed by Electrical Impedance Tomography in Premature Infants.Medicina (Kaunas, Lithuania) · 2024Article
- Potential for recovery after extremely prolonged VV-ECMO support in well-selected severe COVID-19 patients: a retrospective cohort study.BMC pulmonary medicine · 2024Article
- The absolute value of recruitment-to-inflation ratio does not correlate with the recruited volume.Critical care (London, England) · 2023Article
- Future directions of lung-protective ventilation strategies in acute respiratory distress syndrome.Acute medicine & surgeryReview
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Authors and funding
16 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHeterogeneity is an inherent nature of ARDS. Recruitment-to-inflation ratio has been developed to identify the patients who has lung recruitablity. This technique might be useful to identify the patients that match specific interventions, such as higher positive end-expiratory pressure (PEEP) or prone position or both. We aimed to evaluate the physiological effects of PEEP and body position on lung mechanics and regional lung inflation in COVID-19-associated ARDS and to propose the optimal ventilatory strategy based on recruitment-to-inflation ratio.
methodsPatients with COVID-19-associated ARDS were consecutively enrolled. Lung recruitablity (recruitment-to-inflation ratio) and regional lung inflation (electrical impedance tomography [EIT]) were measured with a combination of body position (supine or prone) and PEEP (low 5 cmH
resultsForty-three patients were included. Recruitment-to-inflation ratio was 0.68 (IQR 0.52-0.84), separating high recruiter versus low recruiter. Oxygenation was the same between two groups. In high recruiter, a combination of high PEEP with prone position achieved the highest oxygenation and less dependent silent spaces in EIT (vs. low PEEP in both positions) without increasing non-dependent silent spaces in EIT. In low recruiter, low PEEP in prone position resulted in better oxygenation (vs. both PEEPs in supine position), less dependent silent spaces (vs. low PEEP in supine position) and less non-dependent silent spaces (vs. high PEEP in both positions). Recruitment-to-inflation ratio was positively correlated with the improvement in oxygenation and respiratory system compliance, the decrease in dependent silent spaces, and was inversely correlated with the increase in non-dependent silent spaces, when applying high PEEP.
conclusionsRecruitment-to-inflation ratio may be useful to personalize PEEP in COVID-19-associated ARDS. Higher PEEP in prone position and lower PEEP in prone position decreased the amount of dependent silent spaces (suggesting lung collapse) without increasing the amount of non-dependent silent spaces (suggesting overinflation) in high recruiter and in low recruiter, respectively.
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