目的:评估电阻抗断层扫描(EIT)在优化急性呼吸窘迫综合征(ARDS)患者呼气末正压(PEEP)以增强呼吸系统力学并预防呼吸机相关性肺损伤(VILI)中的功效。与传统方法相比。
方法:我们进行了系统综述和荟萃分析,2012年1月至2023年5月的文学,来自Scopus,PubMed,MEDLINE(Ovid),科克伦,和LILACS,与传统方法相比,评估了EIT指导的PEEP策略在ARDS中的应用。13项研究(3项随机,使用随机效应模型对涉及623例ARDS患者的主要结局(呼吸力学和机械动力)和次要结局(PaO2/FiO2比,死亡率,住在重症监护病房(ICU),无呼吸机日)。
结果:EIT引导的PEEP显着改善了肺顺应性(n=941例,平均差(MD)=4.33,95%置信区间(CI)[2.94,5.71]),降低的机械功率(n=148,MD=-1.99,95%CI[-3.51,-0.47]),与传统方法相比,驱动压力降低(n=903,MD=-1.20,95%CI[-2.33,-0.07])。敏感性分析显示,在随机临床试验中,EIT引导的PEEP对肺顺应性的积极作用与非随机研究汇总(MD)=2.43(95%CI-0.39至5.26),表明有改善的趋势。死亡率降低(259名患者,在三项研究中,相对危险度(RR)=0.64,95%CI[0.45,0.91])与依从性和驱动压力的适度改善相关.
结论:EIT促进实时,个性化PEEP调整,改善呼吸系统力学。整合EIT作为机械通气的指导工具在预防呼吸机引起的肺损伤方面具有潜在的益处。大规模研究对于验证和优化EIT在ARDS管理中的临床应用至关重要。
OBJECTIVE: Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods.
METHODS: We carried out a systematic
review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO2/FiO2 ratio, mortality, stays in intensive care unit (ICU), ventilator-free days).
RESULTS: EIT-guided PEEP significantly improved lung compliance (n = 941 cases, mean difference (MD) = 4.33, 95% confidence interval (CI) [2.94, 5.71]), reduced mechanical power (n = 148, MD = - 1.99, 95% CI [- 3.51, - 0.47]), and lowered driving pressure (n = 903, MD = - 1.20, 95% CI [- 2.33, - 0.07]) compared to traditional methods. Sensitivity analysis showed consistent positive effect of EIT-guided PEEP on lung compliance in randomized clinical trials vs. non-randomized studies pooled (MD) = 2.43 (95% CI - 0.39 to 5.26), indicating a trend towards improvement. A reduction in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) was associated with modest improvements in compliance and driving pressure in three studies.
CONCLUSIONS: EIT facilitates real-time, individualized PEEP adjustments, improving respiratory system mechanics. Integration of EIT as a guiding tool in mechanical ventilation holds potential benefits in preventing ventilator-induced lung injury. Larger-scale studies are essential to validate and optimize EIT\'s clinical utility in ARDS management.