Intraoperative Individualization of Positive-end-expiratory Pressure Through Electrical Impedance Tomography or Esophageal Pressure Assessment: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Overview

Journal J Clin Monit Comput

Publisher Springer

Specialties Anesthesiology
General Medicine
Medical Informatics

Date 2023 Oct 20

PMID 37863862

Authors

Teresa Esposito

Martina Fregonese

Giulio Morettini

Paloma Carboni

Cecilia Tardioli

Antonio Messina

Rosanna Vaschetto

Francesco Della Corte

Luigi Vetrugno

Paolo Navalesi

Edoardo De Robertis

Danila Azzolina

Annop Piriyapatsom

Mauro R Tucci

Hermann Wrigge

Philipp Simon

Elena Bignami

Salvatore M Maggiore

Rachele Simonte

Gianmaria Cammarota

Affiliations

Soon will be listed here.

Abstract

Purpose: This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO/FiO), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment (intervention) vs. PEEP not tailored on EIT or Pes (control), in patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach.

Methods: PUBMED®, EMBASE®, and Cochrane Controlled Clinical trials register were searched for observational studies and RCTs from inception to the end of August 2022. Inclusion criteria were: RCTs comparing PEEP titrated on EIT/Pes assessment vs. PEEP not individualized on EIT/Pes and reporting intraoperative PaO/FiO. Two authors independently extracted data from the enrolled investigations. Data are reported as mean difference and 95% confidence interval (CI).

Results: Six RCTs were included for a total of 240 patients undergoing general anesthesia for surgery, of whom 117 subjects in the intervention group and 123 subjects in the control group. The intraoperative mean PaO/FiO was 69.6 (95%CI 32.-106.4 ) mmHg higher in the intervention group as compared with the control group with 81.4% between-study heterogeneity (p < 0.01). However, at meta-regression, the between-study heterogeneity diminished to 44.96% when data were moderated for body mass index (estimate 3.45, 95%CI 0.78-6.11, p = 0.011).

Conclusions: In patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach, PEEP personalized by EIT or Pes allowed the achievement of a better intraoperative oxygenation compared to PEEP not individualized through EIT or Pes.

Prospero Registration Number: CRD 42021218306, 30/01/2023.

Citing Articles

Electrical impedance tomography-guided positive end-expiratory pressure titration for perioperative oxygenation and postoperative pulmonary complications: A systematic review and meta-analysis.

Chen L, Yu K, Yang J, Han X, Liu L, Li T Medicine (Baltimore). 2025; 103(52):e40357.

PMID: 39969340 PMC: 11688048. DOI: 10.1097/MD.0000000000040357.

Clinical implementation of advanced respiratory monitoring with esophageal pressure and electrical impedance tomography: results from an international survey and focus group discussion.

Wisse J, Scaramuzzo G, Pellegrini M, Heunks L, Piraino T, Somhorst P Intensive Care Med Exp. 2024; 12(1):93.

PMID: 39432136 PMC: 11493933. DOI: 10.1186/s40635-024-00686-9.

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