End-expiratory Transpulmonary Pressure-guided vs Electrical Impedance Tomography-guided PEEP Titration Methods in Patients With Intra-abdominal Hypertension Combined With Acute Respiratory Distress Syndrome: a Randomized Crossover Controlled Study

"The intervention, Transpulmonary Pressure-Guided PEEP Titration in IAH and ARDS Patients, utilizes real-time transpulmonary pressure measurements (alveolar pressure minus pleural pressure, estimated via esophageal manometry) to individualize PEEP settings. This approach accounts for the impact of intra-abdominal hypertension (IAH) on pleural pressure and lung compliance, ensuring precise alveolar recruitment while minimizing overdistension and ventilation-induced lung injury (VILI). PEEP is titrated to maintain a positive end-expiratory transpulmonary pressure (e.g., \>0 cmH₂O) and optimal driving pressures, dynamically adjusted based on intra-abdominal pressure and lung mechanics. This method integrates advanced esophageal pressure monitoring with traditional parameters such as plateau pressure, compliance, and PaO₂/FiO₂ to guide clinical decisions. By addressing the pathophysiological interplay between thoracic and abdominal compartments, the intervention aims to enhance oxygen."

"The intervention, EIT-Guided PEEP Titration in IAH and ARDS Patients, utilizes electrical impedance tomography (EIT) to optimize PEEP settings based on real-time, regional lung ventilation and perfusion distribution. This approach differs from conventional methods that rely on global oxygenation or compliance indices by providing dynamic, bedside imaging of lung mechanics and aeration patterns. In patients with intra-abdominal hypertension (IAH) and ARDS, EIT identifies areas of alveolar overdistension and collapse, allowing precise PEEP titration to achieve optimal lung recruitment while minimizing ventilation-induced lung injury (VILI). The intervention dynamically adjusts PEEP levels to balance regional ventilation, enhance oxygenation, and mitigate the effects of IAH on thoracic mechanics. By integrating advanced imaging technology with traditional ventilatory parameters, this method offers a personalized strategy to improve respiratory mechanics and clinical outcomes."