Lung EIT Image Guide Ventilation in ARDS

Inclusion criteria

• Patients with ARDS receiving mechanical ventilation who meet the following diagnostic criteria:

• Triggered by acute risk factors such as pneumonia, non-pulmonary infection, trauma, transfusion, aspiration, or shock. Pulmonary edema is not entirely or predominantly attributable to cardiogenic causes or fluid overload, and hypoxemia/gas exchange impairment is not mainly due to atelectasis. However, ARDS can be diagnosed in the presence of these conditions if predisposing risk factors exist.
• Acute onset or worsening of hypoxemic respiratory failure within 1 week of the identified risk factor or onset of new or worsening respiratory symptoms.
• Bilateral opacities on chest radiograph or CT, or bilateral B-lines and/or consolidation on ultrasound, not fully explained by effusion, atelectasis, or nodules/masses.
• PaO₂/FiO₂ ≤ 300 mm Hg or SpO₂/FiO₂ ≤ 315 (if SpO₂ ≤ 97%).
• ARDS onset within 1 week.
• Mechanical ventilation ≤ 72 hours.

Exclusion criteria

• Age < 18 years.
• Pregnancy.
• Contraindications to EIT application (e.g., local skin lesions, cardiac pacemaker).
• Contraindications to prone positioning (e.g., increased intracranial pressure, intra-abdominal hypertension, spinal fractures).
• Evidence of barotrauma such as pneumothorax, mediastinal emphysema, or subcutaneous emphysema.
• End-stage disease.
• Informed consent not signed by legal guardians or family.