Anegundi SS, Kurdi MS, Sutagatti JG, Theerth KA. Role of lung ultrasound in assessing positive end expiratory pressure induced lung recruitment in patients on mechanical ventilation. World J Crit Care Med 2025; 14(3): 102609 [DOI: 10.5492/wjccm.v14.i3.102609]
Corresponding Author of This Article
Madhuri S Kurdi, MD, Professor, Department of Anaesthesiology and Critical Care, Karnataka Medical College and Research Institute, Hubballi 580022, Karnataka, India. drmadhuri_kurdi@yahoo.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2025; 14(3): 102609 Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.102609
Role of lung ultrasound in assessing positive end expiratory pressure induced lung recruitment in patients on mechanical ventilation
Shreyas S Anegundi, Madhuri S Kurdi, Jagadish G Sutagatti, Kaushik A Theerth
Shreyas S Anegundi, Jagadish G Sutagatti, Department of Radio-Diagnosis, Karnataka Medical College and Research Institute, Hubballi 580022, Karnataka, India
Madhuri S Kurdi, Department of Anaesthesiology and Critical Care, Karnataka Medical College and Research Institute, Hubballi 580022, Karnataka, India
Kaushik A Theerth, Department of Anaesthesiology and Critical Care, Medical Trust Hospital, Ernakulam 682016, Kerala, India
Author contributions: Anegundi SS, Kurdi MS designed the study; Anegundi SS and Sutagattti JG conducted the study; Kurdi MS supervised the study; Theerth KA wrote the study and contributed to the analysis.
Institutional review board statement: This study was reviewed and approved by Karnataka Medical College and Research Institute, Hubballi-580022, Karnataka, India.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items—and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drmadhuri_kurdi@yahoo.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Madhuri S Kurdi, MD, Professor, Department of Anaesthesiology and Critical Care, Karnataka Medical College and Research Institute, Hubballi 580022, Karnataka, India. drmadhuri_kurdi@yahoo.com
Received: November 4, 2024 Revised: January 28, 2025 Accepted: February 21, 2025 Published online: September 9, 2025 Processing time: 268 Days and 9.5 Hours
Abstract
BACKGROUND
Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).
AIM
To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.
METHODS
An observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H2O)] were applied. Baseline characteristics, including oxygen saturation (SpO2), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.
RESULTS
In this study, 45.9% of patients required a PEEP of 5 cm H2O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H2O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (P < 0.001 for 5 and 10 cm H2O and P = 0.032 for 15 cm H2O). SpO2 increased significantly with higher PEEP levels (P < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.
CONCLUSION
Increasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.
Core Tip: Increasing positive end expiratory pressure (PEEP) in titrated doses is a recruitment strategy aimed at improving oxygenation. The effectiveness of PEEP can vary across different lung pathologies and may not always correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs). In this study, the effect of incremental PEEP levels (5 cm H2O intervals) was evaluated in mechanically ventilated patients with various lung pathologies. Significant improvement in LUS in the posteroinferior zone was observed, along with a simultaneous increase in oxygen saturation. Minimal PEEP was sufficient for lung recruitment in postoperative patients, whereas patients with alveolar filling defects and restrictive lung diseases required higher PEEP levels.
