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Technology-Enhanced Strategies to Optimize Positive End-Expiratory Pressure in Patients Receiving Invasive Mechanical
Adam J Boulton1, Adel Elfeky2,3, Rachel Court2,3
1Warwick Clinical Trials Units, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Critical Care Medicine
|May 28, 2026
Summary
Technology-enhanced positive end-expiratory pressure (PEEP) optimization may reduce mortality in ICU patients but does not shorten mechanical ventilation duration. Further high-quality trials are needed to confirm these findings.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Medical Technology
Background:
- Positive end-expiratory pressure (PEEP) is crucial for mechanical ventilation in ICUs.
- Optimizing PEEP can improve patient outcomes.
- Technology-enhanced strategies aim to personalize PEEP settings.
Purpose of the Study:
- To systematically review the clinical and cost-effectiveness of technology-enhanced PEEP optimization.
- To evaluate these strategies in adult and pediatric patients on invasive mechanical ventilation.
- To synthesize evidence from randomized controlled trials.
Main Methods:
- Systematic review of randomized studies from major databases (MEDLINE, Embase) up to July 2024.
- Inclusion of studies comparing technology-enhanced PEEP optimization with standard care.
- Data extraction and risk of bias assessment using established tools (Revised Cochrane tool).
Main Results:
- 34 studies (2951 patients) were included, evaluating 7 technologies.
- No significant reduction in mechanical ventilation duration was found (very low-certainty evidence).
- A significant reduction in 28-day mortality was observed (risk ratio 0.69; very low-certainty evidence).
Conclusions:
- Technology-enhanced PEEP optimization may reduce mortality in ICU patients.
- These strategies did not significantly decrease the duration of mechanical ventilation.
- Low to very low certainty of evidence necessitates further large-scale randomized trials.
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