Purpose:

Assessing effcacy of electrical impedance tomography(ElT)in optimizing positive end-expiratory pressure(PEEP)for acute respiratory distress syndrome(ARDS)patients to enhance respiratory system mechanics and preventventilator-induced lung injury (VILl),compared to traditional methods.

Methods:

We carried out a systematic review and meta-analysis,spanning literature from January 2012 to May 2023sourced from Scopus,PubMed,MEDLINE(Ovid),Cochrane,and LILACs,evaluated ElT-guided PEEP strategies in ARDsversus conventional methods.Thirteen studies(3 randomized,10 non-randomized)involving 623 ARDs patients wereanalyzed using random-effects models for primary outcomes(respiratory mechanics and mechanical power) andsecondary outcomes(Pao,/fi0,ratio,mortality,stays in intensive care unit(ICU),ventilator-free days).

Results:

ElT-guided PEEP signifcantly improved lung compliance(n=941 cases,mean diference(MD)=4.33,95%confdence interval (Cl)[2.94,5.71]),reduced mechanical power (n=148,MD=-1.99,95%Cl[-3.51,-0.47]),andlowered driving pressure (n=903,MD=-1.20,95%Cl[-2.33,-0.07])compared to traditional methods.Sensitivitanalysis showed consistent positive effect of ElT-guided PEEP on lung compliance in randomized clinical trials vs.nonrandomized studies pooled (MD)=2.43(95%C1-0.39 to 5.26),indicating a trend towards improvement.A reductionin mortality rate(259 patients,relative risk(RR)=0.64,95%Cl [0.45,0.91])was associated with modest improvements.bliance and driving pressure in three studies.

Concrusions:

ElT facilitates real-time,individualized PEEP adjustments,improving respiratory system mechanicsIntegration ot Ell as a guiding tool in mechanical ventilation holds potential benehts in preventing ventilator-inducedlung injury.Larger-scale studies are essential to validate and optimize ElT's clinical utility in ARDS management.

Keywords:

Mechanical ventilation,Ventilator-induced lung injury,ARDSNet