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Springer Science and Business Media LLC Critical Care 28(1)
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    초록·키워드

    Extracorporeal Carbon Dioxide Removal (ECCO<sub>2</sub>R) is used in acute respiratory distress syndrome (ARDS) patients to facilitate lung-protective ventilatory strategies. Electrical Impedance Tomography (EIT) allows individual, non-invasive, real-time, bedside, radiation-free imaging of the lungs, providing global and regional dynamic lung analyses. To provide new insights for future ECCO2R research in ARDS, we propose a potential application of EIT to personalize End-Expiratory Pressure (PEEP) following each reduction in tidal volume (VT), as demonstrated in an illustrative case. A 72-year-old male with COVID-19 was admitted to the ICU for moderate ARDS. Monitoring with EIT was started to determine the optimal PEEP value (PEEP<sub>EIT</sub>), defined as the intersection of the collapse and overdistention curves, after each reduction in VT during ECCO<sub>2</sub>R. The identified PEEP<sub>EIT</sub> values were notably low (< 10 cmH2O). The decrease in VT associated with PEEP<sub>EIT</sub> levels resulted in improved lung compliance, reduced driving pressure and a more uniform ventilation pattern. Despite current Randomized Controlled Trials showing that ultra-protective ventilation with ECCO<sub>2</sub>R does not improve survival, the applicability of universal ultra-protective ventilation settings for all patients remains a subject of debate. Inappropriately set PEEP levels can lead to alveolar collapse or overdistension, potentially negating the benefits of VT reduction. EIT facilitates real-time monitoring of derecruitment associated with VT reduction, guiding physicians in determining the optimal PEEP value after each decrease in tidal volume. This original description of using EIT under ECCO<sub>2</sub>R to adjust PEEP at a level compromising between recruitability and overdistention could be a crucial element for future research on ECCO<sub>2</sub>R.

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