ArticleCritical care (London, England)2025
Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO.
Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- ECMO for patients with obesity: evidence and practice.Intensive care medicine · 2026Review
- The six phases of prolonged veno-venous extracorporeal membrane oxygenator support: a conceptual framework.Critical care (London, England) · 2026Review
- Association Between Positive End-Expiratory Pressure at Venovenous Extracorporeal Membrane Oxygenation Initiation and Liberation Outcomes in Acute Respiratory Distress Syndrome: A Multicenter Retrospective Study.Critical care explorations · 2026Article
- Recent advances in experimental and clinical applications of chest electrical impedance tomography: a narrative review.Intensive care medicine experimental · 2026Review
- Real-time stress and strain monitoring at the bedside: new frontiers in mechanical ventilation.Frontiers in medicine · 2025Review
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleThe significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established.
objectivesTo compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes.
methodsInitially, a low-flow insufflation was performed to detect and measure the airway opening pressure (AOP). Subsequently, the R/I ratio was calculated from PEEP 15-5 cmH MAIN
resultsAmong 54 ECMO patients (tidal volume: 4.8 [3.0-6.0] mL/kg), 13 (24%) exhibited an airway opening pressure (AOP) of 11 (8-14) cmH
conclusionThe R/I ratio is feasible during ultra-protective ventilation and provides valuable indications for guiding PEEP titration. Specifically, an R/I ratio > 0.34 may help identify patients likely to benefit from further individualized PEEP optimization using EIT. In contrast, when the R/I ratio is ≤ 0.34, a moderate PEEP level (8-10 cmH₂O) may suffice.
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