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Sarkar S, Yalla B, Khanna P, Baishya M. Is EIT-guided positive end-expiratory pressure titration for optimizing PEEP in ARDS the white elephant in the room? A systematic review with meta-analysis and trial sequential analysis. J Clin Monit Comput 2024:10.1007/s10877-024-01158-x. [PMID: 38619718 DOI: 10.1007/s10877-024-01158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/23/2024] [Indexed: 04/16/2024]
Abstract
Electrical Impedance Tomography (EIT) is a novel real-time lung imaging technology for personalized ventilation adjustments, indicating promising results in animals and humans. The present study aimed to assess its clinical utility for improved ventilation and oxygenation compared to traditional protocols. Comprehensive electronic database screening was done until 30th November, 2023. Randomized controlled trials, controlled clinical trials, comparative cohort studies, and assessments of EIT-guided PEEP titration and conventional methods in adult ARDS patients regarding outcome, ventilatory parameters, and P/F ratio were included. Our search retrieved five controlled cohort studies and two RCTs with 515 patients and overall reduced risk of mortality [RR = 0.68; 95% CI: 0.49 to 0.95; I2 = 0%], better dynamic compliance [MD = 3.46; 95% CI: 1.59 to 5.34; I2 = 0%] with no significant difference in PaO2/FiO2 ratio [MD = 6.5; 95%CI -13.86 to 26.76; I2 = 74%]. The required information size except PaO2/FiO2 was achieved for a power of 95% based on the 50% reduction in risk of mortality, 10% improved compliance as the cumulative Z-score of the said outcomes crossed the alpha spending boundary and did not dip below the inner wedge of futility. EIT-guided individualized PEEP titration is a novel modality; further well-designed studies are needed to substantiate its utility.
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Affiliation(s)
- Soumya Sarkar
- Department of Anaesthesiology, AIIMS, Kalyani, India
| | - Bharat Yalla
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Puneet Khanna
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, 110029, India.
| | - Madhurjya Baishya
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, Ansari Nagar, New Delhi, 110029, India
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Pupier T, Gallo É, Bonnardel E, Boisselier C, Perrier V, Repusseau B, Rozé H. Daily Evolution of Lung Dependent-Area Collapse Between Prone Position Sessions in ARDS Evaluated by Electrical Impedance Tomography. Respir Care 2024; 69:470-473. [PMID: 38471736 PMCID: PMC11108115 DOI: 10.4187/respcare.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Thomas Pupier
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Éloïse Gallo
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Eline Bonnardel
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Clément Boisselier
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Virginie Perrier
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Benjamin Repusseau
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France
| | - Hadrien Rozé
- Drs Pupier, Gallo, Bonnardel, Boisselier, Perrier, and Repusseau are affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France. Dr Rozé is affiliated with CHU de Bordeaux, Service d'Anesthésie Réanimation Thoraco-Abdominale, F-33600 Pessac, France; Réanimation Polyvalente, Centre Hospitalier Côte Basque, F64100 Bayonne, Centre Hospitalier Côte Basque, F64100 Bayonne, France; Université de Bordeaux, F-33400 Talence, France.
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3
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Franchineau G, Jonkman AH, Piquilloud L, Yoshida T, Costa E, Rozé H, Camporota L, Piraino T, Spinelli E, Combes A, Alcala GC, Amato M, Mauri T, Frerichs I, Brochard LJ, Schmidt M. Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure. Am J Respir Crit Care Med 2024; 209:670-682. [PMID: 38127779 DOI: 10.1164/rccm.202306-1118ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Hypoxemic respiratory failure is one of the leading causes of mortality in intensive care. Frequent assessment of individual physiological characteristics and delivery of personalized mechanical ventilation (MV) settings is a constant challenge for clinicians caring for these patients. Electrical impedance tomography (EIT) is a radiation-free bedside monitoring device that is able to assess regional lung ventilation and changes in aeration. With real-time tomographic functional images of the lungs obtained through a thoracic belt, clinicians can visualize and estimate the distribution of ventilation at different ventilation settings or following procedures such as prone positioning. Several studies have evaluated the performance of EIT to monitor the effects of different MV settings in patients with acute respiratory distress syndrome, allowing more personalized MV. For instance, EIT could help clinicians find the positive end-expiratory pressure that represents a compromise between recruitment and overdistension and assess the effect of prone positioning on ventilation distribution. The clinical impact of the personalization of MV remains to be explored. Despite inherent limitations such as limited spatial resolution, EIT also offers a unique noninvasive bedside assessment of regional ventilation changes in the ICU. This technology offers the possibility of a continuous, operator-free diagnosis and real-time detection of common problems during MV. This review provides an overview of the functioning of EIT, its main indices, and its performance in monitoring patients with acute respiratory failure. Future perspectives for use in intensive care are also addressed.
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Affiliation(s)
- Guillaume Franchineau
- Service de Medecine Intensive Reanimation, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eduardo Costa
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Hadrien Rozé
- Department of Thoraco-Abdominal Anesthesiology and Intensive Care, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
- Réanimation Polyvalente, Centre Hospitalier Côte Basque, Bayonne, France
| | - Luigi Camporota
- Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Thomas Piraino
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Critical Care, Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alain Combes
- Sorbonne Université, Groupe de Recherche Clinique 30, Réanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigüe, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive - Réanimation, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Glasiele C Alcala
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Marcelo Amato
- Pulmonary Division, Cardiopulmonary Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplants, University of Milan, Milan, Italy
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Kiel, Germany; and
| | - Laurent J Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Matthieu Schmidt
- Sorbonne Université, Groupe de Recherche Clinique 30, Réanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigüe, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive - Réanimation, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
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Musso G, Taliano C, De Iuliis M, Paschetta E, Fonti C, Ferraris A, Druetta M, Vianou IS, Ranghino F, Riedo F, Deangelis D, Tirabassi G. Mechanical power normalized to aerated lung predicts noninvasive ventilation failure and death and contributes to the benefits of proning in COVID-19 hypoxemic respiratory failure. EPMA J 2023:1-39. [PMID: 37359998 PMCID: PMC10256581 DOI: 10.1007/s13167-023-00325-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
Background Concern exists that noninvasive ventilation (NIV) may promote ventilation-induced lung injury(VILI) and worsen outcome in acute hypoxemic respiratory failure (AHRF). Different individual ventilatory variables have been proposed to predict clinical outcomes, with inconsistent results.Mechanical power (MP), a measure of the energy transfer rate from the ventilator to the respiratory system during mechanical ventilation, might provide solutions for this issue in the framework of predictive, preventive and personalized medicine (PPPM). We explored (1) the impact of ventilator-delivered MP normalized to well-aerated lung (MPWAL) on physio-anatomical and clinical responses to NIV in COVID-19-related AHRF and (2) the effect of prone position(PP) on MPWAL. Methods We analyzed 216 noninvasively ventilated COVID-19 patients (108 patients receiving PP + NIV and 108 propensity score-matched patients receiving supine NIV) with moderate-to-severe(paO2/FiO2 ratio < 200) AHRF enrolled in the PRO-NIV controlled non-randomized study (ISRCTN23016116).Quantification of differentially aerated lung volumes by lung ultrasonography (LUS) was validated against CT scans. Respiratory parameters were hourly recorded, ABG were performed 1 h after each postural change. Time-weighed average values of ventilatory variables, including MPWAL, and gas exchange parameters (paO2/FiO2 ratio, dead space indices) were calculated for each ventilatory session. LUS and circulating biomarkers were assessed daily. Results Compared with supine position, PP was associated with a 34% MPWAL reduction, attributable largely to an absolute MP reduction and secondly to an enhanced lung reaeration.Patients receiving a high MPWAL during the 1st 24 h of NIV [MPWAL(day 1)] had higher 28-d NIV failure (HR = 4.33,95%CI:3.09 - 5.98) and death (HR = 5.17,95%CI: 3.01 - 7.35) risks than those receiving a low MPWAL(day 1).In Cox multivariate analyses, MPWAL(day 1) remained independently associated with 28-d NIV failure (HR = 1.68,95%CI:1.15-2.41) and death (HR = 1.69,95%CI:1.22-2.32).MPWAL(day 1) outperformed other power measures and ventilatory variables as predictor of 28-d NIV failure (AUROC = 0.89;95%CI:0.85-0.93) and death (AUROC = 0.89;95%CI:0.85-0.94).MPWAL(day 1) predicted also gas exchange, ultrasonographic and inflammatory biomarker responses, as markers of VILI, on linear multivariate analysis. Conclusions In the framework of PPPM, early bedside MPWAL calculation may provide added value to predict response to NIV and guide subsequent therapeutic choices i.e. prone position adoption during NIV or upgrading to invasive ventilation, to reduce hazardous MPWAL delivery, prevent VILI progression and improve clinical outcomes in COVID-19-related AHRF. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00325-5.
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Affiliation(s)
- Giovanni Musso
- Emergency Medicine Department, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043 Turin, TO Italy
| | - Claudio Taliano
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | | | - Elena Paschetta
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | - Caterina Fonti
- Emergency Medicine Department, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043 Turin, TO Italy
| | | | - Marta Druetta
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | | | | | - Federica Riedo
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | - Davide Deangelis
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | - Gloria Tirabassi
- Department of Biomedical Sciences, HUMANITAS University, Via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele Italy
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End-Expiratory Lung Impedance Measured With Electrical Impedance Tomography at Different Days Are Not Comparable. Crit Care Med 2023; 51:e70-e72. [PMID: 36661473 DOI: 10.1097/ccm.0000000000005698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Zhang H, Liu Z, Shu H, Yu Y, Yang X, Li R, Xu J, Zou X, Shang Y. Prone positioning in ARDS patients supported with VV ECMO, what we should explore? J Intensive Care 2022; 10:46. [PMID: 36195935 PMCID: PMC9531855 DOI: 10.1186/s40560-022-00640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS), a prevalent cause of admittance to intensive care units, is associated with high mortality. Prone positioning has been proven to improve the outcomes of moderate to severe ARDS patients owing to its physiological effects. Venovenous extracorporeal membrane oxygenation (VV ECMO) will be considered in patients with severe hypoxemia. However, for patients with severe hypoxemia supported with VV ECMO, the potential effects and optimal strategies of prone positioning remain unclear. This review aimed to present these controversial questions and highlight directions for future research. Main body The clinically significant benefit of prone positioning and early VV ECMO alone was confirmed in patients with severe ARDS. However, a number of questions regarding the combination of VV ECMO and prone positioning remain unanswered. We discussed the potential effects of prone positioning on gas exchange, respiratory mechanics, hemodynamics, and outcomes. Strategies to achieve optimal outcomes, including indications, timing, duration, and frequency of prone positioning, as well as the management of respiratory drive during prone positioning sessions in ARDS patients receiving VV ECMO, are challenging and controversial. Additionally, whether and how to implement prone positioning according to ARDS phenotypes should be evaluated. Lung morphology monitored by computed tomography, lung ultrasound, or electrical impedance tomography might be a potential indication to make an individualized plan for prone positioning therapy in patients supported with VV ECMO. Conclusion For patients with ARDS supported with VV ECMO, the potential effects of prone positioning have yet to be clarified. Ensuring an optimal strategy, especially an individualized plan for prone positioning therapy during VV ECMO, is particularly challenging and requires further research.
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Affiliation(s)
- Hongling Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, 237000, China
| | - Zhengdong Liu
- Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, 237000, China
| | - Huaqing Shu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuan Yu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaobo Yang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ruiting Li
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiqian Xu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaojing Zou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Scott JB, Weiss TT, Li J. COVID-19 Lessons Learned: Prone Positioning With and Without Invasive Ventilation. Respir Care 2022; 67:1011-1021. [PMID: 35882445 PMCID: PMC9994154 DOI: 10.4187/respcare.10141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prone positioning (PP) has been used extensively for patients requiring invasive mechanical ventilation for hypoxemic respiratory failure during the COVID-19 pandemic. Evidence suggests that PP was beneficial during the pandemic, as it improves oxygenation and might improve chances of survival, especially in those with a continuum of positive oxygenation responses to the procedure. Additionally, the pandemic drove innovation regarding PP, as it brought attention to awake PP (APP) and the value of an interdisciplinary team approach to PP during a pandemic. APP appears to be safe and effective at improving oxygenation; APP may also reduce the need for intubation in patients requiring advanced respiratory support like high-flow nasal cannula or noninvasive ventilation. Teams specifically assembled for PP during a pandemic also appear useful and can provide needed assistance to bedside clinicians in the time of crisis. Complications associated with PP can be mitigated, and a multidisciplinary approach to reduce the incidence of complications is recommended.
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Affiliation(s)
- J Brady Scott
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois.
| | - Tyler T Weiss
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois
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Abstract
OBJECTIVE To describe, through a narrative review, the physiologic principles underlying electrical impedance tomography, and its potential applications in managing acute respiratory distress syndrome (ARDS). To address the current evidence supporting its use in different clinical scenarios along the ARDS management continuum. DATA SOURCES We performed an online search in Pubmed to review articles. We searched MEDLINE, Cochrane Central Register, and clinicaltrials.gov for controlled trials databases. STUDY SELECTION Selected publications included case series, pilot-physiologic studies, observational cohorts, and randomized controlled trials. To describe the rationale underlying physiologic principles, we included experimental studies. DATA EXTRACTION Data from relevant publications were reviewed, analyzed, and its content summarized. DATA SYNTHESIS Electrical impedance tomography is an imaging technique that has aided in understanding the mechanisms underlying multiple interventions used in ARDS management. It has the potential to monitor and predict the response to prone positioning, aid in the dosage of flow rate in high-flow nasal cannula, and guide the titration of positive-end expiratory pressure during invasive mechanical ventilation. The latter has been demonstrated to improve physiologic and mechanical parameters correlating with lung recruitment. Similarly, its use in detecting pneumothorax and harmful patient-ventilator interactions such as pendelluft has been proven effective. Nonetheless, its impact on clinically meaningful outcomes remains to be determined. CONCLUSIONS Electrical impedance tomography is a potential tool for the individualized management of ARDS throughout its different stages. Clinical trials should aim to determine whether a specific approach can improve clinical outcomes in ARDS management.
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