Tommaso Mauri, Marco Leali, Elena Spinelli, Gaetano Scaramuzzo, Massimo Antonelli, Domenico L Grieco, Savino Spadaro, Giacomo Grasselli
{"title":"Omics approach to chest electrical impedance tomography reveals physiological cluster of ARDS characterised by increased respiratory drive and effort.","authors":"Tommaso Mauri, Marco Leali, Elena Spinelli, Gaetano Scaramuzzo, Massimo Antonelli, Domenico L Grieco, Savino Spadaro, Giacomo Grasselli","doi":"10.1186/s13613-025-01514-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Non-invasive assessment of respiratory drive and effort in spontaneously breathing ARDS patients is challenging, yet clinically relevant. We explored whether hierarchical clustering applied to electrical impedance tomography (EIT- a radiation-free non-invasive lung imaging technique) identifies ARDS sub-phenotypes with increased drive and effort.</p><p><strong>Results: </strong>Thirty intubated patients with ARDS on assisted mechanical ventilation were monitored by EIT and esophageal pressure during a decremental positive end-expiratory pressure (PEEP) trial. A comprehensive EIT assessment was made (computed variables n = 180) during tidal breathing at different PEEP levels. Agglomerative nesting was applied to scaled data distances. Three clusters of ARDS were identified: inhomogeneous ventilation, unmatched V'/Q, and mismatched V'/Q. The unmatched V'/Q cluster had the highest respiratory drive (p = 0.045) and effort (p = 0.021) at lower PEEP, and experienced longer length of ICU stay (p = 0.019).</p><p><strong>Conclusions: </strong>Higher PEEP levels reduced drive of the unmatched V'/Q cluster, mitigating the physiological differences. Clustering approaches to EIT data identify physiologically and clinically relevant sub-phenotypes of ARDS.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"90"},"PeriodicalIF":5.7000,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-025-01514-3","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Non-invasive assessment of respiratory drive and effort in spontaneously breathing ARDS patients is challenging, yet clinically relevant. We explored whether hierarchical clustering applied to electrical impedance tomography (EIT- a radiation-free non-invasive lung imaging technique) identifies ARDS sub-phenotypes with increased drive and effort.
Results: Thirty intubated patients with ARDS on assisted mechanical ventilation were monitored by EIT and esophageal pressure during a decremental positive end-expiratory pressure (PEEP) trial. A comprehensive EIT assessment was made (computed variables n = 180) during tidal breathing at different PEEP levels. Agglomerative nesting was applied to scaled data distances. Three clusters of ARDS were identified: inhomogeneous ventilation, unmatched V'/Q, and mismatched V'/Q. The unmatched V'/Q cluster had the highest respiratory drive (p = 0.045) and effort (p = 0.021) at lower PEEP, and experienced longer length of ICU stay (p = 0.019).
Conclusions: Higher PEEP levels reduced drive of the unmatched V'/Q cluster, mitigating the physiological differences. Clustering approaches to EIT data identify physiologically and clinically relevant sub-phenotypes of ARDS.
期刊介绍:
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.