Currently submitted to: JMIR Cardio
Date Submitted: Apr 22, 2026
Open Peer Review Period: May 19, 2026 - Jul 14, 2026
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Precision PEEP Titration in Cardiac Surgery: Transitioning from Global Mechanics to EIT-Guided Regional Ventilation Management
ABSTRACT
During the perioperative phase of cardiac surgery, the intricate interplay between pulmonary ischemia-reperfusion injury, protracted mechanical ventilation, and systemic inflammatory responses frequently precipitates significant lung injury. To address this, implementing individualized positive end-expiratory pressure (PEEP) aims to bolster respiratory function and effectively mitigate the incidence of postoperative pulmonary complications. The fundamental mechanism of PEEP involves facilitating alveolar recruitment and averting alveolar collapse, thereby restoring functional residual capacity. Given the caveats of potential circulatory suppression, academic focus has increasingly pivoted toward identifying optimal PEEP titration strategies. Although various individualized protocols have been proposed, they often present a trade-off between clinical precision and practical utility. Electrical Impedance Tomography (EIT) offers a dynamic solution by monitoring regional ventilation distribution, providing the real-time feedback essential for precise PEEP titration. For post-cardiac surgery patients burdened by high transport risks, EIT’s inherent non-invasive, radiation-free, and bedside capabilities substantially enhance the safety and operational feasibility of individualized PEEP management.
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