Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography - a randomized controlled trial

Jonas Weber; Jan Gutjahr; Johannes Schmidt; Sara Lozano-Zahonero; Silke Borgmann; Stefan Schumann; Steffen Wirth

doi:10.1186/s12871-020-00960-9

Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography - a randomized controlled trial

BMC Anesthesiol. 2020 Feb 20;20(1):42. doi: 10.1186/s12871-020-00960-9.

Authors

Jonas Weber¹, Jan Gutjahr², Johannes Schmidt², Sara Lozano-Zahonero², Silke Borgmann², Stefan Schumann², Steffen Wirth²

Affiliations

¹ Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. jonas.weber@uniklinik-freiburg.de.
² Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.

Abstract

Background: The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients.

Methods: After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH₂O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (C_RS) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography.

Results: The frequencies of the C_RS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH₂O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028].

Conclusions: Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found.

Trial registration: This clinical trial was registered at the German Register for Clinical Trials (DRKS00008924) on August 10, 2015.

Keywords: Compliance profile analysis; Gliding-SLICE; Mechanical ventilation; PEEP titration; Respiratory system mechanics.

Publication types

Randomized Controlled Trial

MeSH terms

Electric Impedance
Female
Humans
Lung / physiology*
Male
Middle Aged
Positive-Pressure Respiration / methods*
Respiratory Mechanics / physiology*
Tidal Volume / physiology

Associated data

DRKS/DRKS00008924