Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial

Chi-Ards Net (Chinese ARDS Research Network); Xueyan Yuan; Ming Zhong; Zhe Li; Ling Sang; Xiaobo Huang; Rui Zhang; Hui Chen; Yuan Gao; Yuxian Wang; Zhimin Lin; Sen Lu; Fang Yang; Tao Chen; Lanqi Guo; Jianfeng Xie; Zhanqi Zhao; Yingzi Huang; Yi Yang; Tommaso Mauri; Haibo Qiu; Ling Liu

doi:10.1093/ajrccm/aamaf125

Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial

Chi-Ards Net (Chinese ARDS Research Network)
, Xueyan Yuan
, Ming Zhong
, Zhe Li
, Ling Sang
, Xiaobo Huang
, Rui Zhang
, Hui Chen
, Yuan Gao
, Yuxian Wang
, Zhimin Lin
, Sen Lu
, Fang Yang
, Tao Chen
, Lanqi Guo
, Jianfeng Xie
, Zhanqi Zhao
, Yingzi Huang
, Yi Yang
, Tommaso Mauri

Haibo Qiu, Ling Liu

Clinical Sciences

Southeast University, Nanjing
Zhongshan Hospital
Fudan University
Shanghai Jiao Tong University
First Affiliated Hospital of Guangzhou Medical University
Guangzhou Medical College
University of Electronic Science and Technology of China
University of York
Chinese Academy of Medical Sciences
Furtwangen University
IRCCS Fondazione Ca'Granda – Ospedale Maggiore Policlinico - Milano
University of Milan

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

RATIONALE: Physiological studies showed benefits for bedside setting of personalized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT), balancing lung overdistension and collapse. OBJECTIVES: To evaluate whether EIT-guided PEEP improves the clinical outcomes of patients with acute respiratory distress syndrome (ARDS) compared to the lower PEEP/FiO2 table strategy.

METHODS: This randomized trial enrolled adult patients with moderate to severe ARDS across five sites in China from February 2022 to June 2023. Participants were randomly assigned to EIT-guided PEEP (collapse-overdistension crossing point value by decremental PEEP trial) or the classical lower PEEP/FiO2 table. The primary outcome was 28-day mortality.

MEASUREMENTS AND MAIN RESULTS: The trial was terminated early for futility, based on a pre-planned interim analysis. A total of 190 patients were included and completed follow-up. PEEP levels didn't differ between groups during the first 7 days (difference in marginal means 0.2 [SE 0.1]; P = .187). At 28 days, mortality was 52 patients (55.9%) in the EIT-guided PEEP group and 51 patients (52.6%) in the lower PEEP/FiO2 table group (hazard ratio [HR] 0.96 [95% CI, 0.65-1.41]; P = .821). Ventilator-free days and other secondary clinical and safety outcomes did not differ, either. However, EIT-guided PEEP assigned higher PEEP and decreased mortality in patients with higher lung recruitability, as assessed by the recruitment-inflation ratio method (16 [35.6%] of 45 patients vs 27 [60.0%] of 45 patients; HR 0.49 [95% CI, 0.26-0.91]; P = .024).

CONCLUSIONS: In patients with moderate to severe ARDS, EIT-guided PEEP did not significantly reduce 28-day mortality compared with the lower PEEP/FiO2 table strategy. Due to early termination, the study may have been underpowered to detect a clinically important difference.

Original language	English
Pages (from-to)	440-451
Number of pages	12
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	212
Issue number	3
Early online date	23 Jan 2026
DOIs	https://doi.org/10.1093/ajrccm/aamaf125
Publication status	Published - 31 Mar 2026

Keywords

acute respiratory distress syndrome
electrical impedance tomography
lower PEEP/FiO2 table
positive end-expiratory pressure

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10.1093/ajrccm/aamaf125

Electrical impedance tomography-guided PEEP and mortality ofAccepted author manuscript, 368 KBLicence: CC BY

Cite this

Chi-Ards Net (Chinese ARDS Research Network), Yuan, X., Zhong, M., Li, Z., Sang, L., Huang, X., Zhang, R., Chen, H., Gao, Y., Wang, Y., Lin, Z., Lu, S., Yang, F., Chen, T., Guo, L., Xie, J., Zhao, Z., Huang, Y., Yang, Y., ... Liu, L. (2026). Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial. American Journal of Respiratory and Critical Care Medicine, 212(3), 440-451. https://doi.org/10.1093/ajrccm/aamaf125

@article{a1bc5bb67d624a2f87fa3a8148aa4956,

title = "Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial",

abstract = "RATIONALE: Physiological studies showed benefits for bedside setting of personalized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT), balancing lung overdistension and collapse. OBJECTIVES: To evaluate whether EIT-guided PEEP improves the clinical outcomes of patients with acute respiratory distress syndrome (ARDS) compared to the lower PEEP/FiO2 table strategy. METHODS: This randomized trial enrolled adult patients with moderate to severe ARDS across five sites in China from February 2022 to June 2023. Participants were randomly assigned to EIT-guided PEEP (collapse-overdistension crossing point value by decremental PEEP trial) or the classical lower PEEP/FiO2 table. The primary outcome was 28-day mortality. MEASUREMENTS AND MAIN RESULTS: The trial was terminated early for futility, based on a pre-planned interim analysis. A total of 190 patients were included and completed follow-up. PEEP levels didn't differ between groups during the first 7 days (difference in marginal means 0.2 [SE 0.1]; P = .187). At 28 days, mortality was 52 patients (55.9\%) in the EIT-guided PEEP group and 51 patients (52.6\%) in the lower PEEP/FiO2 table group (hazard ratio [HR] 0.96 [95\% CI, 0.65-1.41]; P = .821). Ventilator-free days and other secondary clinical and safety outcomes did not differ, either. However, EIT-guided PEEP assigned higher PEEP and decreased mortality in patients with higher lung recruitability, as assessed by the recruitment-inflation ratio method (16 [35.6\%] of 45 patients vs 27 [60.0\%] of 45 patients; HR 0.49 [95\% CI, 0.26-0.91]; P = .024). CONCLUSIONS: In patients with moderate to severe ARDS, EIT-guided PEEP did not significantly reduce 28-day mortality compared with the lower PEEP/FiO2 table strategy. Due to early termination, the study may have been underpowered to detect a clinically important difference. ",

keywords = "acute respiratory distress syndrome, electrical impedance tomography, lower PEEP/FiO2 table, positive end-expiratory pressure",

author = "\{Chi-Ards Net (Chinese ARDS Research Network)\} and Xueyan Yuan and Ming Zhong and Zhe Li and Ling Sang and Xiaobo Huang and Rui Zhang and Hui Chen and Yuan Gao and Yuxian Wang and Zhimin Lin and Sen Lu and Fang Yang and Tao Chen and Lanqi Guo and Jianfeng Xie and Zhanqi Zhao and Yingzi Huang and Yi Yang and Tommaso Mauri and Haibo Qiu and Ling Liu",

year = "2026",

month = mar,

day = "31",

doi = "10.1093/ajrccm/aamaf125",

language = "English",

volume = "212",

pages = "440--451",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "3",

}

Chi-Ards Net (Chinese ARDS Research Network), Yuan, X, Zhong, M, Li, Z, Sang, L, Huang, X, Zhang, R, Chen, H, Gao, Y, Wang, Y, Lin, Z, Lu, S, Yang, F, Chen, T, Guo, L, Xie, J, Zhao, Z, Huang, Y, Yang, Y, Mauri, T, Qiu, H & Liu, L 2026, 'Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial', American Journal of Respiratory and Critical Care Medicine, vol. 212, no. 3, pp. 440-451. https://doi.org/10.1093/ajrccm/aamaf125

Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial. / Chi-Ards Net (Chinese ARDS Research Network); Yuan, Xueyan; Zhong, Ming et al.
In: American Journal of Respiratory and Critical Care Medicine, Vol. 212, No. 3, 31.03.2026, p. 440-451.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial

AU - Chi-Ards Net (Chinese ARDS Research Network)

AU - Yuan, Xueyan

AU - Zhong, Ming

AU - Li, Zhe

AU - Sang, Ling

AU - Huang, Xiaobo

AU - Zhang, Rui

AU - Chen, Hui

AU - Gao, Yuan

AU - Wang, Yuxian

AU - Lin, Zhimin

AU - Lu, Sen

AU - Yang, Fang

AU - Chen, Tao

AU - Guo, Lanqi

AU - Xie, Jianfeng

AU - Zhao, Zhanqi

AU - Huang, Yingzi

AU - Yang, Yi

AU - Mauri, Tommaso

AU - Qiu, Haibo

AU - Liu, Ling

PY - 2026/3/31

Y1 - 2026/3/31

N2 - RATIONALE: Physiological studies showed benefits for bedside setting of personalized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT), balancing lung overdistension and collapse. OBJECTIVES: To evaluate whether EIT-guided PEEP improves the clinical outcomes of patients with acute respiratory distress syndrome (ARDS) compared to the lower PEEP/FiO2 table strategy. METHODS: This randomized trial enrolled adult patients with moderate to severe ARDS across five sites in China from February 2022 to June 2023. Participants were randomly assigned to EIT-guided PEEP (collapse-overdistension crossing point value by decremental PEEP trial) or the classical lower PEEP/FiO2 table. The primary outcome was 28-day mortality. MEASUREMENTS AND MAIN RESULTS: The trial was terminated early for futility, based on a pre-planned interim analysis. A total of 190 patients were included and completed follow-up. PEEP levels didn't differ between groups during the first 7 days (difference in marginal means 0.2 [SE 0.1]; P = .187). At 28 days, mortality was 52 patients (55.9%) in the EIT-guided PEEP group and 51 patients (52.6%) in the lower PEEP/FiO2 table group (hazard ratio [HR] 0.96 [95% CI, 0.65-1.41]; P = .821). Ventilator-free days and other secondary clinical and safety outcomes did not differ, either. However, EIT-guided PEEP assigned higher PEEP and decreased mortality in patients with higher lung recruitability, as assessed by the recruitment-inflation ratio method (16 [35.6%] of 45 patients vs 27 [60.0%] of 45 patients; HR 0.49 [95% CI, 0.26-0.91]; P = .024). CONCLUSIONS: In patients with moderate to severe ARDS, EIT-guided PEEP did not significantly reduce 28-day mortality compared with the lower PEEP/FiO2 table strategy. Due to early termination, the study may have been underpowered to detect a clinically important difference.

AB - RATIONALE: Physiological studies showed benefits for bedside setting of personalized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT), balancing lung overdistension and collapse. OBJECTIVES: To evaluate whether EIT-guided PEEP improves the clinical outcomes of patients with acute respiratory distress syndrome (ARDS) compared to the lower PEEP/FiO2 table strategy. METHODS: This randomized trial enrolled adult patients with moderate to severe ARDS across five sites in China from February 2022 to June 2023. Participants were randomly assigned to EIT-guided PEEP (collapse-overdistension crossing point value by decremental PEEP trial) or the classical lower PEEP/FiO2 table. The primary outcome was 28-day mortality. MEASUREMENTS AND MAIN RESULTS: The trial was terminated early for futility, based on a pre-planned interim analysis. A total of 190 patients were included and completed follow-up. PEEP levels didn't differ between groups during the first 7 days (difference in marginal means 0.2 [SE 0.1]; P = .187). At 28 days, mortality was 52 patients (55.9%) in the EIT-guided PEEP group and 51 patients (52.6%) in the lower PEEP/FiO2 table group (hazard ratio [HR] 0.96 [95% CI, 0.65-1.41]; P = .821). Ventilator-free days and other secondary clinical and safety outcomes did not differ, either. However, EIT-guided PEEP assigned higher PEEP and decreased mortality in patients with higher lung recruitability, as assessed by the recruitment-inflation ratio method (16 [35.6%] of 45 patients vs 27 [60.0%] of 45 patients; HR 0.49 [95% CI, 0.26-0.91]; P = .024). CONCLUSIONS: In patients with moderate to severe ARDS, EIT-guided PEEP did not significantly reduce 28-day mortality compared with the lower PEEP/FiO2 table strategy. Due to early termination, the study may have been underpowered to detect a clinically important difference.

KW - acute respiratory distress syndrome

KW - electrical impedance tomography

KW - lower PEEP/FiO2 table

KW - positive end-expiratory pressure

U2 - 10.1093/ajrccm/aamaf125

DO - 10.1093/ajrccm/aamaf125

M3 - Article

C2 - 41738148

AN - SCOPUS:105038268619

SN - 1073-449X

VL - 212

SP - 440

EP - 451

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 3

ER -

Chi-Ards Net (Chinese ARDS Research Network), Yuan X, Zhong M, Li Z, Sang L, Huang X et al. Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial. American Journal of Respiratory and Critical Care Medicine. 2026 Mar 31;212(3):440-451. Epub 2026 Jan 23. doi: 10.1093/ajrccm/aamaf125

Electrical impedance tomography-guided positive end-expiratory pressure and mortality of patients with the acute respiratory distress syndrome: the EITVent randomized clinical trial

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