Lung ultrasound in PEEP optimization for ARDS: a randomized controlled study

Abstract Background PEEP optimization in acute respiratory distress syndrome (ARDS) is a controversial issue. Lung ultrasound (LUS) is a potential useful tool in PEEP optimization. Aim This study was intended to investigate the usefulness of LUS as a tool for PEEP optimization in ARDS patients. Methods Prospective randomized controlled trial conducted on ARDS patients that included 60 patients randomized in a 1:1 ratio to either PEEP/FiO 2 table (group I) or lung ultrasound (group II). Results The baseline findings showed more severe ARDS in group I patients with significantly lower P/F ratio ( P = 0.008) and static compliance ( P = 0.02). The use of LUS for PEEP optimization did not result in better improvement in P/F ratio ( P = 0.4), PaCO 2 ( P = 0.2), or static compliance ( P = 0.8). The use of LUS was associated with a favorable effect on hemodynamics with significantly less decrease in CO ( P < 0.001), decreased TAPSE ( P < 0.001), and less increase in right ventricular systolic pressure ( P < 0.001). Despite that the inhospital mortality was significantly lower in group I, this result should be interpreted cautiously because the more severe the ARDS in group I. Conclusion Optimizing PEEP by lung ultrasound in mechanically ventilated ARDS patients might cause better outcomes in terms of oxygenation and hemodynamics indices despite the lack of effect on respiratory system mechanics. The use of LUS in PEEP optimization for ARDS patients needs to be more evaluated.