{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T02:37:51Z","timestamp":1773715071306,"version":"3.50.1"},"reference-count":8,"publisher":"Pensoft Publishers","issue":"6","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p><jats:bold>Introduction<\/jats:bold>: Positive end-expiratory pressure (PEEP) titration is crucial for improving oxygenation and preventing ventilator-induced lung injury in acute hypoxemic respiratory failure. Electrical impedance tomography (EIT) offers real-time, bedside monitoring of lung ventilation distribution, potentially guiding individualized PEEP settings.<\/jats:p>\n          <jats:p><jats:bold>Aim<\/jats:bold>: The aim of this study was to assess the effect of EIT-based PEEP titration on respiratory mechanics and gas exchange in critically ill mechanically ventilated patients with acute hypoxemic respiratory failure.<\/jats:p>\n          <jats:p><jats:bold>Materials and methods<\/jats:bold>: A prospective, interventional study was conducted from April 2022 to January 2024, including adult patients with acute hypoxemic respiratory failure on invasive mechanical ventilation. Continuous EIT monitoring was performed with electrode belts positioned at the fourth to fifth intercostal space. Patients were divided into two groups, low and high recruiters, based on the absolute reduction of the collapse percentage in the dorsal lung segments measured by EIT when increasing PEEP from 6 mbar to 20 mbar. EIT data, respiratory mechanics parameters and arterial blood gases were obtained during PEEP titration maneuvers. Optimum PEEP based on EIT was defined as the crossing point of the collapse and overdistention curves, generated during decremental PEEP trial.<\/jats:p>\n          <jats:p><jats:bold>Results<\/jats:bold>: A total of 45 patients with a mean age of 54.33 years were included in the study. In low recruiters, the EIT-based PEEP was lower (9.18\u00b12.11) than baseline PEEP (10.73\u00b13.07) (<jats:italic>p<\/jats:italic>=0.0008). In high recruiters, the EIT-based PEEP was higher (13.91\u00b12.45) than baseline PEEP (10.22\u00b12.24) (<jats:italic>p<\/jats:italic>=0.0006). A statistically significant positive correlation was found between BMI and EIT-based PEEP. The crossing point method of PEEP titration led to improvement of oxygenation in high recruiters and improvement of respiratory mechanics parameters in low recruiters.<\/jats:p>\n          <jats:p><jats:bold>Conclusion<\/jats:bold>: As a non-invasive and radiation-free monitoring tool EIT allows personalization of PEEP titration with minimum alveolar collapse and overdistention.<\/jats:p>","DOI":"10.3897\/folmed.66.e134512","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T15:12:47Z","timestamp":1735917167000},"page":"869-875","source":"Crossref","is-referenced-by-count":2,"title":["PEEP titration guided by electrical impedance tomography in critically ill mechanically ventilated patients with acute hypoxemic respiratory failure"],"prefix":"10.3897","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-0098","authenticated-orcid":true,"given":"Dimitar","family":"Kazakov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4438-5413","authenticated-orcid":true,"given":"Emral","family":"Kyosebekirov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5269-5770","authenticated-orcid":true,"given":"Siyana","family":"Nikolova-Kamburova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-0906","authenticated-orcid":true,"given":"Valentin","family":"Stoilov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1316-6176","authenticated-orcid":true,"given":"Emil","family":"Mitkovski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgi","family":"Pavlov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-8570","authenticated-orcid":true,"given":"Chavdar","family":"Stefanov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7289-0829","authenticated-orcid":true,"given":"Milena","family":"Sandeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2258","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"key":"134512_B1","doi-asserted-by":"crossref","unstructured":"1. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315(8):788\u2013800.","DOI":"10.1001\/jama.2016.0291"},{"key":"134512_B2","doi-asserted-by":"crossref","unstructured":"2. Network TARDS. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342(18):1301\u20138. Available from: http:\/\/www.nejm.org\/doi\/abs\/10.1056\/NEJM200005043421801","DOI":"10.1056\/NEJM200005043421801"},{"key":"134512_B3","doi-asserted-by":"crossref","unstructured":"3. Adrien J, Petit M, Vieillard-Baron A. Hemodynamic effects of positive end-expiratory pressure. Curr Opin Crit Care 2024; 30(1):10\u20139. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/38085886\/","DOI":"10.1097\/MCC.0000000000001124"},{"key":"134512_B4","doi-asserted-by":"crossref","unstructured":"4. Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006; 354(17):1775\u201386. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/16641394\/","DOI":"10.1056\/NEJMoa052052"},{"key":"134512_B5","doi-asserted-by":"crossref","unstructured":"5. Frerichs I, Amato MBP, van Kaam AH, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax 2017; 72(1):83\u201393. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27596161","DOI":"10.1136\/thoraxjnl-2016-208357"},{"key":"134512_B6","doi-asserted-by":"crossref","unstructured":"6. Costa EL, Borges JB, Melo A, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med 2009; 35(6):1132\u20137. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19255741","DOI":"10.1007\/s00134-009-1447-y"},{"key":"134512_B7","doi-asserted-by":"crossref","unstructured":"7. Jonkman AH, Alcala GC, Pavlovsky B, et al. Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT): a multicenter study of COVID-19 acute respiratory distress syndrome. Am J Respir Crit Care Med 2023; 208(1):25\u201338. Available from: https:\/\/www.atsjournals.org\/doi\/10.1164\/rccm.202212-2300OC","DOI":"10.1164\/rccm.202212-2300OC"},{"key":"134512_B8","doi-asserted-by":"crossref","unstructured":"8. Somhorst P, Van der Zee P, Endeman H, et al. PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS. Crit Care 2022; 26(1):272. 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