TY - JOUR
T1 - Individualized PEEP can improve both pulmonary hemodynamics and lung function in acute lung injury
AU - Sousa, Mayson L.A.
AU - Menga, Luca S.
AU - Schreiber, Annia
AU - Docci, Mattia
AU - Vieira, Fernando
AU - Katira, Bhushan H.
AU - Pellegrini, Mariangela
AU - Dubo, Sebastian
AU - Douflé, Ghislaine
AU - Costa, Eduardo L.V.
AU - Post, Martin
AU - Amato, Marcelo B.P.
AU - Brochard, Laurent
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/12
Y1 - 2025/12
N2 - Rationale: There are several approaches to select the optimal positive end-expiratory pressure (PEEP), resulting in different PEEP levels. The impact of different PEEP settings may extend beyond respiratory mechanics, affecting pulmonary hemodynamics. Objectives: To compare PEEP levels obtained with three titration strategies—(i) highest respiratory system compliance (CRS), (ii) electrical impedance tomography (EIT) crossing point; (iii) positive end-expiratory transpulmonary pressure (PL)—in terms of regional respiratory mechanics and pulmonary hemodynamics. Methods: Experimental studies in two porcine models of acute lung injury: (I) bilateral injury induced in both lungs, generating a highly recruitable model (n = 37); (II) asymmetrical injury, generating a poorly recruitable model (n = 13). In all experiments, a decremental PEEP titration was performed monitoring PL, EIT (collapse, overdistention, and regional ventilation), respiratory mechanics, and pulmonary and systemic hemodynamics. Measurements and main results: PEEP titration methods resulted in different levels of median optimal PEEP in bilateral lung injury: 14(12–14) cmH2O for CRS, 11(10–12) cmH2O for EIT, and 8(8–10) cmH2O for PL, p < 0.001. Differences were less pronounced in asymmetrical lung injury. PEEP had a quadratic U-shape relationship with pulmonary artery pressure (R2 = 0.94, p < 0.001), right-ventricular systolic transmural pressure, and pulmonary vascular resistance. Minimum values of pulmonary vascular resistance were found around individualized PEEP, when ventilation distribution and pulmonary circulation were simultaneously optimized. Conclusions: In porcine models of acute lung injury with variable lung recruitability, both low and high levels of PEEP can impair pulmonary hemodynamics. Optimized ventilation and hemodynamics can be obtained simultaneously at PEEP levels individualized based on respiratory mechanics, especially by EIT and esophageal pressure.
AB - Rationale: There are several approaches to select the optimal positive end-expiratory pressure (PEEP), resulting in different PEEP levels. The impact of different PEEP settings may extend beyond respiratory mechanics, affecting pulmonary hemodynamics. Objectives: To compare PEEP levels obtained with three titration strategies—(i) highest respiratory system compliance (CRS), (ii) electrical impedance tomography (EIT) crossing point; (iii) positive end-expiratory transpulmonary pressure (PL)—in terms of regional respiratory mechanics and pulmonary hemodynamics. Methods: Experimental studies in two porcine models of acute lung injury: (I) bilateral injury induced in both lungs, generating a highly recruitable model (n = 37); (II) asymmetrical injury, generating a poorly recruitable model (n = 13). In all experiments, a decremental PEEP titration was performed monitoring PL, EIT (collapse, overdistention, and regional ventilation), respiratory mechanics, and pulmonary and systemic hemodynamics. Measurements and main results: PEEP titration methods resulted in different levels of median optimal PEEP in bilateral lung injury: 14(12–14) cmH2O for CRS, 11(10–12) cmH2O for EIT, and 8(8–10) cmH2O for PL, p < 0.001. Differences were less pronounced in asymmetrical lung injury. PEEP had a quadratic U-shape relationship with pulmonary artery pressure (R2 = 0.94, p < 0.001), right-ventricular systolic transmural pressure, and pulmonary vascular resistance. Minimum values of pulmonary vascular resistance were found around individualized PEEP, when ventilation distribution and pulmonary circulation were simultaneously optimized. Conclusions: In porcine models of acute lung injury with variable lung recruitability, both low and high levels of PEEP can impair pulmonary hemodynamics. Optimized ventilation and hemodynamics can be obtained simultaneously at PEEP levels individualized based on respiratory mechanics, especially by EIT and esophageal pressure.
KW - Acute lung injury
KW - Mechanical ventilation
KW - Positive end-expiratory pressure
KW - Pulmonary hemodynamics
KW - Pulmonary vascular resistance
UR - http://www.scopus.com/inward/record.url?scp=86000727223&partnerID=8YFLogxK
U2 - 10.1186/s13054-025-05325-7
DO - 10.1186/s13054-025-05325-7
M3 - Article
C2 - 40065461
AN - SCOPUS:86000727223
SN - 1364-8535
VL - 29
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 107
ER -