BACKGROUND The application of positive end-expiratory pressure (PEEP) may reduce dynamic strain during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy for titrating optimal PEEP. By analyzing intratidal compliance profiles, PEEP may be individually titrated for patients. METHODS After obtaining informed consent, 60 consecutive patients undergoing general anesthesia were randomly allocated to mechanical ventilation with PEEP 5 cmH2O (control group) or PEEP individually titrated, guided by an analysis of the intratidal compliance profile (intervention group). The primary endpoint was the frequency of each nonlinear intratidal compliance (CRS) profile of the respiratory system (horizontal, increasing, decreasing, and mixed). The secondary endpoints measured were respiratory mechanics, hemodynamic variables, and regional ventilation, which was assessed via electrical impedance tomography. RESULTS The frequencies of the CRS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH2O, p < 0.001], the respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3)%; dorsal: 25.9 (13.8)%] than in the intervention group [ventral: 29.3 (17.6)%; dorsal: 16.4 (12.7)%; p (ventral) = 0.039, p (dorsal) = 0.028]. CONCLUSIONS Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies. Individualized PEEP titration resulted in slightly higher PEEP. A slight global increase in aeration associated with this was indicated by regional gain and loss analysis. Differences in dorsal to ventral ventilation distribution were not found. TRIAL REGISTRATION This clinical trial was registered at the German Register for Clinical Trials (DRKS00008924) on August 10, 2015.

中文翻译：

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潮气内顺应性分析指导的个体化PEEP滴定对通过电阻抗断层摄影术评估的区域通气的影响-一项随机对照试验。

背景技术呼气末正压（PEEP）的施加可以减少机械通气期间的动态应变。尽管已经提出了许多用于PEEP滴定的方法，但是还没有公认的滴定最佳PEEP的策略。通过分析潮气内顺应性，可以为患者单独滴定PEEP。方法在获得知情同意后，连续60例接受全身麻醉的患者被随机分配到机械通气中，PEEP 5 cmH2O（对照组）或PEEP单独滴定，并根据潮气内顺应性进行分析（干预组）。主要终点是呼吸系统各个水平的潮气内顺应性（CRS）曲线的频率（水平，递增，递减和混合）。测量的次要终点是呼吸力学，血液动力学变量和区域通气，这些均通过电阻抗断层扫描进行评估。结果CRS谱的频率在两组之间是可比的。除了PEEP [对照：5.0（0.0），干预：5.8（1.1）cmH2O，p <0.001]，两组的呼吸和血液动力学变量相当。依从性概况分析显示两组之间没有显着差异。对照组腹侧和背侧区域通气的损失更高[腹侧：41.0（16.3）％；背侧：25.9（13.8）％]比干预组[腹侧：29.3（17.6）％；背：16.4（12.7）％; p（腹侧）＝ 0.039，p（背侧）＝ 0.028]。结论与早期研究相比，发现顺应性不良的资料表明潮汐减少。单独的PEEP滴定导致PEEP稍高。区域损益分析表明，与此相关的全球通气量略有增加。没有发现背侧到腹侧通气分布的差异。试验注册该临床试验已于2015年8月10日在德国临床试验注册簿（DRKS00008924）中进行了注册。