ArticleAmerican journal of respiratory and critical care medicine2026
Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients.
Article in American journal of respiratory and critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- ARDS 60th anniversary: spontaneous breathing in ARDS.Intensive care medicine · 2026Article
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Abstract
rationaleTidal recruitment/derecruitment (R/D) is a well-known mechanism of lung injury in acute respiratory distress syndrome (ARDS) patients, but its bedside identification is challenging during assisted ventilation.
objectivesTo investigate bedside determinants of tidal R/D assessed by electrical impedance tomography (EIT) in spontaneously breathing ARDS patients on pressure support ventilation (PSV).
methodsThis is a secondary analysis of a previous study including lightly sedated ARDS patients ventilated on PSV at 2 positive end-expiratory pressure (PEEP) levels selected by EIT (PEEPEIT) and low PEEP/FiO2 table (PEEPTABLE). Detailed physiological assessment was performed, including respiratory mechanics, inspiratory drive and effort, regional mechanics, and tidal R/D measured by EIT. MEASUREMENTS AND MAIN
resultsOf 30 original patients, 1 was excluded due to unstable end-expiratory lung impedance, leaving 29 patients for analysis. Median PEEP was 10.0 (IQR 8.0-12.0) cmH2O with PEEPEIT and 8.0 (IQR 5.0-10.0) cmH2O with PEEPTABLE. Overall, tidal R/D was 14.3% (IQR 9.0-33.0), but it was lower at PEEPEIT vs PEEPTABLE (11.3% [IQR 4.8-20.5] vs 21.9% [IQR 6.8-31.7]; P = .008). Recruitment/derecruitment reduction with PEEPEIT correlated with decreases in collapse (rho = 0.72; P < .001) and pendelluft (rho = 0.57; P = .002). Analyzing data from both randomized PEEPs together, mixed-effects models showed higher tidal R/D at lower PEEP (P < .001), more negative end-expiratory transpulmonary pressure (PLEnd-Exp) (P < .001), larger collapse (P < .001), and lower lung compliance (P = .002). Higher respiratory drive (P = .001), effort (P = .009), and dynamic driving transpulmonary pressure (P = .009) correlated with higher tidal R/D. Patients with nonfocal infiltrates presented higher tidal R/D (P = .005). At multivariable analysis, PLEnd-Exp, lung collapse, and nonfocal pattern were independently associated tidal R/D.
conclusionIn spontaneously breathing ARDS patients on PSV, the main determinants of tidal R/D are more negative PLEnd-Exp, higher lung collapse, and nonfocal infiltrates.
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