Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients.

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Τίτλος:	Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients.
Συγγραφείς:	Perez J; Department of Physical Therapy and Rehabilitation, Anchorena San Martín Clinic, Buenos Aires, Argentina.; Department of Emergency Medicine, Carlos G. Durand Hospital, Buenos Aires, Argentina., Leali M; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Spinelli E; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Maggiore Policlinico Hospital, Milan, Italy., Chiavieri V; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Rosà T; Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy., Ferrara P; Department of Translational Medicine, University of Ferrara, Sant'Anna Hospital, Ferrara, Italy.; Department of Emergency Medicine, Intensive care Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy., Scaramuzzo G; Department of Translational Medicine, University of Ferrara, Sant'Anna Hospital, Ferrara, Italy.; Department of Emergency Medicine, Intensive care Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy., Antonelli M; Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy., Grasselli G; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Maggiore Policlinico Hospital, Milan, Italy., Grieco DL; Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy., Spadaro S; Department of Translational Medicine, University of Ferrara, Sant'Anna Hospital, Ferrara, Italy.; Department of Emergency Medicine, Intensive care Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy., Mauri T; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Maggiore Policlinico Hospital, Milan, Italy.
Πηγή:	American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2026 Sep 01; Vol. 212 (9), pp. 2175-2186.
Τύπος έκδοσης:	Journal Article
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: American Thoracic Society Country of Publication: England NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
Imprint Name(s):	Publication: 2000- : New York, NY : American Thoracic Society Original Publication: New York, NY : American Lung Association, c1994-
Ιατρικοί όροι (MeSH):	Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/diagnostic imaging , Positive-Pressure Respiration/methods , Tomography/methods , Tidal Volume/physiology , Electric Impedance*, Respiratory Mechanics/physiology ; Humans ; Female ; Male ; Middle Aged ; Aged
Περίληψη:	Rationale: 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. Objectives: To investigate bedside determinants of tidal R/D assessed by electrical impedance tomography (EIT) in spontaneously breathing ARDS patients on pressure support ventilation (PSV). Methods: 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. Measurements and Main Results: 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 = .008). Recruitment/derecruitment reduction with PEEPEIT correlated with decreases in collapse (rho = 0.72; P < .001) and pendelluft (rho = 0.57; P = .002). Analyzing data from both randomized PEEPs together, mixed-effects models showed higher tidal R/D at lower PEEP (P < .001), more negative end-expiratory transpulmonary pressure (PLEnd-Exp) (P < .001), larger collapse (P < .001), and lower lung compliance (P = .002). Higher respiratory drive (P = .001), effort (P = .009), and dynamic driving transpulmonary pressure (P = .009) correlated with higher tidal R/D. Patients with nonfocal infiltrates presented higher tidal R/D (P = .005). At multivariable analysis, PLEnd-Exp, lung collapse, and nonfocal pattern were independently associated tidal R/D. Conclusion: 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. (© The Author(s) 2026. Published by Oxford University Press on behalf of the American Thoracic Society.)
Σχόλια:	Comment in: Am J Respir Crit Care Med. 2026 Sep 1;212(9):2122-2123. doi: 10.1093/ajrccm/aamag316.. (PMID: 42319904)
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Grant Information:	Department of Anesthesia, Critical Care and Emergency; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Italian Ministry of Health; Hub Life Science; Diagnostica Avanzata; Piano Nazionale Complementare Ecosistema Innovativo della Salute; Italian Ministry of Education and Research; 2023-2027 Dipartimenti di Eccellenza Program; Department of Pathophysiology and Transplantation; University of Milan
Contributed Indexing:	Keywords: acute respiratory distress syndrome; assisted ventilation; electrical impedance tomography; physiologic monitoring; ventilator-induced lung injury
Entry Date(s):	Date Created: 20260525 Date Completed: 20260827 Latest Revision: 20260917
Update Code:	20260918
PubMed Central ID:	PMC13519317
DOI:	10.1093/ajrccm/aamag246
PMID:	42178817
Βάση Δεδομένων:	MEDLINE

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ISSN:	1535-4970
DOI:	10.1093/ajrccm/aamag246