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Updated: Sep 5, 2025

Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics
Published on: April 19, 2024
Methods for Determination of Individual PEEP for Intraoperative Mechanical Ventilation Using a Decremental PEEP
Felix Girrbach1, Franziska Zeutzschel1,2, Susann Schulz1
1Department of Anesthesiology and Intensive Care, University of Leipzig Medical Center, 04103 Leipzig, Germany.
Individual positive end-expiratory pressure (PEEP) settings optimize lung mechanics. PEEP selection based on best quasi-static or dynamic compliance showed high agreement with the RVDI method, suggesting it is favorable for clinical practice.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Individualized positive end-expiratory pressure (PEEP) settings may enhance intraoperative oxygenation and lung mechanics.
- Optimal methods for determining individualized PEEP (PEEPIND) remain uncertain.
Purpose of the Study:
- To compare different methods for determining PEEPIND.
- To evaluate the agreement between PEEPIND determined by electrical impedance tomography (EIT)-based methods and compliance-based methods.
Main Methods:
- Secondary analysis of a randomized controlled trial.
- Offline analysis of decremental PEEP trials.
- Retrospective determination of PEEPIND using five methods: EIT-based (RVDI, Global Inhomogeneity Index [GI], EIT tidal ventilation [EIT VT]) and global dynamic and quasi-static compliance.
Main Results:
- PEEPIND using the RVDI method (PEEPRVD) was 16.3 ± 4.5 cm H2O.
- PEEPIND determined by GI and EIT VT showed significant differences compared to PEEPRVD (p=0.01).
- PEEPIND selection based on quasi-static compliance demonstrated the highest agreement with PEEPRVD (p=0.67).
- PEEPIND based on dynamic compliance also showed high agreement with PEEPRVD (p=0.57).
Conclusions:
- High agreement exists between PEEPIND determined by the RVDI method and compliance-based methods.
- PEEP selection based on best quasi-static or dynamic compliance is favorable for routine clinical practice.
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