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Especially in the context of ARDS, so-called protective ventilation strategies must be followed. However, determining the optimal PEEP settings in clinical routines is challenging.

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Electrical impedance tomography EIT is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting.

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ARDS was induced by a double-hit approach in 18 pigs weighing, on average, Subsequently, pigs were randomized to either the EIT or control groups, followed by an observation time of 24 h. At defined time points, hemodynamic measures, ventilation parameters, and EIT recordings, as well as blood samples, were taken. After euthanization, lungs were removed for subsequent histopathological and cytological examination.

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The combination of PEEP and F IO 2 differed between groups, although respiratory compliance, gas exchange, and histopathological examinations, as well as hemodynamics, did not show any statistical differences between the EIT and control groups.

However, in our relatively short ARDS observation period of 24 h, no significant differences appeared in common clinical parameters compared with a control group.