{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:45:36Z","timestamp":1787856336838,"version":"build-2784847793"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Department of Anesthesia, Critical Care and Emergency"},{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hub Life Science"},{"name":"Diagnostica Avanzata"},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Piano Nazionale Complementare Ecosistema Innovativo della Salute"},{"name":"Italian Ministry of Education and Research"},{"name":"Dipartimenti di Eccellenza Program","award":["2023-2027"],"award-info":[{"award-number":["2023-2027"]}]},{"name":"Department of Pathophysiology and Transplantation"},{"DOI":"10.13039\/100012352","name":"University of Milan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Tidal 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate bedside determinants of tidal R\/D assessed by electrical impedance tomography (EIT) in spontaneously breathing ARDS patients on pressure support ventilation (PSV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Of 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\u2009=\u2009.008). Recruitment\/derecruitment reduction with PEEPEIT correlated with decreases in collapse (rho\u2009=\u20090.72; P\u2009&amp;lt;\u2009.001) and pendelluft (rho\u2009=\u20090.57; P\u2009=\u2009.002). Analyzing data from both randomized PEEPs together, mixed-effects models showed higher tidal R\/D at lower PEEP (P\u2009&amp;lt;\u2009.001), more negative end-expiratory transpulmonary pressure (PLEnd-Exp) (P\u2009&amp;lt;\u2009.001), larger collapse (P\u2009&amp;lt;\u2009.001), and lower lung compliance (P\u2009=\u2009.002). Higher respiratory drive (P\u2009=\u2009.001), effort (P\u2009=\u2009.009), and dynamic driving transpulmonary pressure (P\u2009=\u2009.009) correlated with higher tidal R\/D. Patients with nonfocal infiltrates presented higher tidal R\/D (P\u2009=\u2009.005). At multivariable analysis, PLEnd-Exp, lung collapse, and nonfocal pattern were independently associated tidal R\/D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In spontaneously breathing ARDS patients on PSV, the main determinants of tidal R\/D are more negative PLEnd-Exp, higher lung collapse, and nonfocal infiltrates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag246","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T12:09:18Z","timestamp":1778674158000},"page":"2175-2186","source":"Crossref","is-referenced-by-count":2,"title":["Determinants of tidal recruitment\/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients"],"prefix":"10.1093","volume":"212","author":[{"given":"Joaquin","family":"Perez","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Rehabilitation, Anchorena San Mart\u00edn Clinic , Buenos Aires,","place":["Argentina"]},{"name":"Department of Emergency Medicine, Carlos G. 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Gemelli IRCCS , Rome,","place":["Italy"]},{"name":"Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart , Rome,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Ferrara, Sant\u2019Anna Hospital , Ferrara,","place":["Italy"]},{"name":"Department of Emergency Medicine, Intensive care Unit, Azienda Ospedaliera Universitaria di Ferrara , Ferrara,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-4082","authenticated-orcid":false,"given":"Gaetano","family":"Scaramuzzo","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Ferrara, Sant\u2019Anna Hospital , Ferrara,","place":["Italy"]},{"name":"Department of Emergency Medicine, Intensive care Unit, Azienda Ospedaliera Universitaria di Ferrara , Ferrara,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. 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