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Background  High positive end-expiratory pressures (PEEP) may induce overdistension/recruitment and affect ventilation–perfusion matching (VQMatch) in mechanically ventilated patients. This study aimed to investigate the association between PEEP-induced lung overdistension/recruitment and VQMatch by electrical impedance tomography (EIT).    Methods  The study was conducted prospectively on 30 adult mechanically ventilated patients: 18/30 with ARDS and 12/30 with high risk for ARDS. EIT measurements were performed at zero end-expiratory pressures (ZEEP) and subsequently at high (12–15 cmH 2 O) PEEP. The number of overdistended pixels over the number of recruited pixels (O/R ratio) was calculated, and the patients were divided into low O/R (O/R ratio < 15%) and high O/R groups (O/R ratio ≥ 15%). The global inhomogeneity (GI) index was calculated to evaluate the ventilation distribution. Lung perfusion image was calculated from the EIT impedance–time curves caused by 10 ml 10% NaCl injection during a respiratory pause (> 8 s). DeadSpace % , Shunt % , and VQMatch %  were calculated based on lung EIT perfusion and ventilation images.    Results  Increasing PEEP resulted in recruitment mainly in dorsal regions and overdistension mainly in ventral regions. ΔVQMatch %  (VQMatch %  at high PEEP minus that at ZEEP) was significantly correlated with recruited pixels ( r  = 0.468,  P  = 0.009), overdistended pixels ( r  = − 0.666,  P  < 0.001), O/R ratio ( r  = − 0.686,  P  < 0.001), and ΔSpO 2  ( r  = 0.440,  P  = 0.015). Patients in the low O/R ratio group (14/30) had significantly higher Shunt %  and lower VQMatch %  than those in the high O/R ratio group (16/30) at ZEEP but not at high PEEP. Comparable DeadSpace %  was found in both groups. A high PEEP caused a significant improvement of VQMatch % , DeadSpace % , Shunt % , and GI in the low O/R ratio group, but not in the high O/R ratio group. Using O/R ratio of 15% resulted in a sensitivity of 81% and a specificity of 100% for an increase of VQMatch %  > 20% in response to high PEEP.    Conclusions  Change of ventilation–perfusion matching was associated with regional overdistention and recruitment induced by PEEP. A low O/R ratio induced by high PEEP might indicate a more homogeneous ventilation and improvement of VQMatch.    Trial registration  ClinicalTrials.gov,  NCT04081155 . Registered on 9 September 2019—retrospectively registered.

critical care

Influence of overdistension/recruitment induced by high positive end-expiratory pressure on ventilation–perfusion matching assessed by electrical impedance tomography with saline bolus