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
; 38(4): 873-883, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38619718
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.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Síndrome de Dificultad Respiratoria
/
Tomografía
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Respiración con Presión Positiva
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Impedancia Eléctrica
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Pulmón
Límite:
Humans
Idioma:
En
Revista:
J Clin Monit Comput
Asunto de la revista:
INFORMATICA MEDICA
/
MEDICINA
Año:
2024
Tipo del documento:
Article
País de afiliación:
India
Pais de publicación:
HOLANDA
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HOLLAND
/
NETHERLANDS
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NL
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PAISES BAJOS
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THE NETHERLANDS