{
  "abstract": "Background Determining the optimal positive end-expiratory pressure (PEEP) to maximize alveolar recruitment while minimizing overdistension remains a clinical challenge. This study investigated the relationship between transpulmonary pressures and alveolar collapse/overdistension, as assessed by electrical impedance tomography (EIT), in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Methods We conducted a physiological study involving 38 mechanically ventilated ARDS patients. Each patient underwent a decremental PEEP trial (20 to 4 cmH₂O), with continuous EIT monitoring and esophageal pressure measurements to calculate end-expiratory (P L,e ) and end-inspiratory (P L,i ) transpulmonary pressures. Percentages of alveolar collapse and overdistension were derived from EIT data. The predictive value of P L,e and P L,i for critical alveolar collapse or overdistension (> 10%) was assessed. We also compared PEEP levels determined by EIT-guided (best compromise between overdistension and collapse) versus esophageal pressure-guided (lowest PEEP yielding a positive P L,e ) strategies. Results P L,e and P L,i strongly correlated with alveolar collapse (r = − 0.68) and overdistension (r = 0.60), respectively (both p < 0.001). Receiver operating characteristic analysis showed good predictive performance of P L,e (AUC = 0.84) and P L,i (AUC = 0.80) for identifying critical collapse and overdistension. A P L,e <2.0 cmH₂O predicted collapse > 10%, while P L,i >18.4 cmH₂O predicted overdistension > 10%, both with ≥ 80% specificity. PEEP levels determined using EIT were significantly higher than those based on esophageal pressure (12.0 [8.0–14.0] vs . 8.0 [4.8–11.3) cmH 2 O; p < 0.001), resulting in reduced alveolar collapse, indicating more effective alveolar recruitment, and improved ventilation in dependent lung region. However, EIT-guided strategy also led to a slight increase in overdistension and reduced compliance in the non-dependent lung. Conclusions P L,e and P L,i accurately identified clinically relevant thresholds of collapse and overdistension, supporting their role as physiologic surrogates of regional lung stress in ARDS. However, EIT- and esophageal-guided strategies result in different PEEP settings, respiratory mechanics, and patterns of alveolar collapse and overdistension.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "name": "Clément Brault"
    },
    {
      "name": "Yoann Zerbib"
    },
    {
      "name": "Romain Vallee"
    },
    {
      "name": "Rosalie Schoux"
    },
    {
      "name": "Alexis Lambour"
    },
    {
      "name": "Benjamin Swinyard"
    },
    {
      "name": "Valentin Dambrine"
    },
    {
      "name": "Julien Demaiter"
    },
    {
      "name": "Loay Kontar"
    },
    {
      "name": "Julien Maizel"
    },
    {
      "name": "Michel Slama"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dzkgekdqwre23.bib",
  "cited_by": 0,
  "doi": "10.1186/s13054-026-06356-4",
  "fulltext_url": null,
  "id": "dzkgekdqwre23",
  "issns": [
    "1364-8535",
    "1466-609X"
  ],
  "landing_url": "https://u-picardie.hal.science/hal-05766980v1",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.mhep"
    ],
    [
      "hal",
      "2.sdv.mhep.psr"
    ],
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7214389942",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-25",
  "publisher": "BioMed Central",
  "ris": "https://research.draconitic.com/paper/dzkgekdqwre23.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:42Z",
      "native_id": "hal-05766980",
      "source": "hal",
      "url": "https://u-picardie.hal.science/hal-05766980v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:0.sdv",
      "subfield": "general"
    },
    {
      "field": "medicine",
      "origin": "hal:1.sdv.mhep",
      "subfield": "general"
    }
  ],
  "title": "Transpulmonary pressures and EIT-derived alveolar collapse and overdistension in ARDS: association and comparison of two PEEP titration strategies",
  "title_text": "Transpulmonary pressures and EIT-derived alveolar collapse and overdistension in ARDS: association and comparison of two PEEP titration strategies",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:42Z",
  "url": "https://research.draconitic.com/paper/dzkgekdqwre23",
  "venue": "Critical Care",
  "versions": []
}