Publication date: Dec 08, 2025
Severe acute respiratory failure from COVID-19 is associated with high mortality. Optimal positive end-expiratory pressure (PEEP) titration is essential for lung-protective ventilation; however, different strategies may elicit distinct clinical responses. To compare the short-term effects of three PEEP titration strategies on lung injury score (LIS), changes in oxygenation, respiratory mechanics, and electrical impedance tomography (EIT) measures in mechanically ventilated patients with COVID-19. In this randomized, parallel-group trial, 75 intubated patients were randomly assigned to EIT-guided PEEP (PEEP-EIT), driving pressure-guided PEEP (PEEP-DP), or ARDSNet-based PEEP (PEEP-ARDSNet). Primary outcome was change in lung injury score (LIS); secondary outcomes included PaO₂/FiO₂ ≥ 150 mmHg, PaO₂/FiO₂ response ≥ 20 mmHg, driving pressure reduction, compliance increase, EIT-based regional ventilation and aeration, and adverse events within a four-hour follow-up. Mean PEEP levels differed across groups: PEEP-EIT (13. 3 cmH₂O), PEEP-DP (10. 6 cmH₂O), and ARDSNet (12 cmH₂O). PEEP-EIT showed greater LIS reduction (OR 3. 7, 1. 58 – 8. 57; p = 0. 004) and higher odds of oxygenation response vs. PEEP-DP (OR 4. 2, 2. 15 – 8. 27; p
| Concepts | Keywords |
|---|---|
| Driving | COVID-19 |
| Hour | Electrical impedance |
| Lung | Mechanical ventilation |
| Outperformed | Respiratory mechanics |
| Tomography |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 |
| disease | MESH | lung injury |
| disease | MESH | included |