Physiology-Based Individualized PEEP Titration and Its Effect on Respiratory Mechanics and Oxygenation in ARDS: A Prospective Observational Study: Individualized PEEP Titration and Respiratory Mechanics and Oxygenation in ARDS

Anum Mehboob; Muhammad Asim Rana; Ezaz Yousaf; Rizwan Pervaiz; Rameeza Khalid; Yasir Ali Zaidi; Fatima Shakil

doi:10.54393/pjhs.v7i9.4061

Authors

Anum Mehboob Department of Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
Muhammad Asim Rana Department of Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
Ezaz Yousaf Department of Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
Rizwan Pervaiz Department of Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
Rameeza Khalid Department of Anesthesia, Bahria International Hospital, Lahore, Pakistan
Yasir Ali Zaidi Department of Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
Fatima Shakil Department of Medicine, St. Luke's General Hospital, Kilkenny, Ireland

DOI:

https://doi.org/10.54393/pjhs.v7i9.4061

Keywords:

Acute Respiratory Distress Syndrome, Positive-Pressure Respiration, End-Expiratory Pressure, Mechanical Ventilation, Respiratory Mechanics, Oxygenation

Abstract

Acute Respiratory Distress Syndrome (ARDS) has high morbidity and mortality and often requires mechanical ventilation. Bedside, physiology-guided titration of positive end-expiratory pressure (PEEP) may improve lung mechanics, oxygenation, and reduce ventilator-induced lung injury. Objectives: To determine the impact of physiology-based PEEP titration individualized on respiratory mechanics, oxygenation, hemodynamics, and clinical outcome in patients with ventilated ARDS. Methods: This is a pre and post-quasi-experimental study (Jan-Dec 2025) at the Medical and Surgical ICUs of Bahria International Hospital, Lahore. Adult patients with ARDS in need of invasive ventilation were enrolled. PEEP was progressively regulated at the bedside depending on compliance, driving pressure, oxygenation, and imaging. The main outcome measurements consisted of compliance, driving pressure, and PaO2/FiO2 changes, whereas secondary measures were the length of ventilation, ICU hospitalization, barotrauma, and death in the ICU. Results: Among 120 patients (mean age 54.2 ± 14.6 years; 60% male), individualized PEEP titration improved compliance (32.5 ± 6.8 → 38.7 ± 7.2 mL/cmH₂O, p<0.01), reduced driving pressure (15.6 ± 3.4 → 12.8 ± 3.0 cmH₂O, p<0.01), and increased PaO₂/FiO₂ (140 ± 35 → 195 ± 42 mmHg, p<0.01). There were minimal hemodynamic effects. Median ventilation period was 9 days, ICU stay 12 days; barotrauma 5%, ICU mortality 28%. Conclusions: PEEP titration based on physiology and monitored at the bedside is safe, feasible, and effective in enhancing lung mechanics and oxygenation in patients with ARDS, and it should be included in lung-protective ventilation.

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