Optimizing PEEP

Decremental PEEP Studies

EIT (electrical impedance tomography)

EIT utilizes the changes in bioelectrical impedance to extract information and provides dynamic images of ventilation at the bedside. There are no RCTs on EIT in ARDS.

PEEP tables (ARDSNet)

Esophageal manometry

• In 2009, Talmor et al. showed in the NEJM that in 61 patients, esophageal pressure guidance in ARDS as compared to ARDSNet table led to a durable increase of the PF ratio of 88 mmHg as compared to ARDSNet titration.
• The EPVent2 (2019) trial showed that routine PEEP titration with esophageal pressure guidance (manometry) did not improve outcomes compared to empiric high PEEP-FiO2 strategy in moderate to severe ARDS. (link)