Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome

Frontiers in Medicine

article

Chun Pan¹  Lu Chen²  Bin Du⁴  Haibo Qiu¹  Cong Lu²  Xiaobin She⁵  Haibo Ren⁶  Huazhang Wei⁷  Liang Xu⁸  Yingzi Huang¹  Jia'an Xia⁹  Yuetian Yu^1,10 

[1] Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University;Department of Critical Care, Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital;Interdepartmental Division of Critical Care Medicine, University of Toronto;Medical Intensive Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences;Department of Critical Care Medicine, Qinghai University Affiliated Hospital;Department of Critical Care Medicine, Wuhan Asia General Hospital;Department of Critical Care Medicine, Jinggangshan University Affiliated Hospital;Department of Critical Care Medicine, Wuhan Wuchang Hospital;Department of Critical Care Medicine, Wuhan Jinyintan Hospital;Department of Critical Care Medicine, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University

关键词: acute respiratory distress syndrome;    coronavirus disease 2019;    positive end-expiratory pressure;    mechanical ventilation;    lung injury;   

DOI  :  10.3389/fmed.2021.637747

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Different positive end-expiratory pressure (PEEP) strategies are available for subjects with coronavirus disease 2019 (COVID-19)–induced acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. We aimed to evaluate three conventional PEEP strategies on their effects on respiratory mechanics, gas exchanges, and hemodynamics. Methods: This is a prospective, physiologic, multicenter study conducted in China. We recruited 20 intubated subjects with ARDS and confirmed COVID-19. We first set PEEP by the ARDSnet low PEEP–fraction of inspired oxygen (F IO 2 ) table. After a recruitment maneuver, PEEP was set at 15, 10, and 5 cm H 2 O for 10 min, respectively. Among these three PEEP levels, best-compliance PEEP was the one providing the highest respiratory system compliance; best-oxygenation PEEP was the one providing the highest Pa O 2 (partial pressure of arterial oxygen)/FIO 2 . Results: At each PEEP level, we assessed respiratory mechanics, arterial blood gas, and hemodynamics. Among three PEEP levels, plateau pressure, driving pressure, mechanical power, and blood pressure improved with lower PEEP. The ARDSnet low PEEP–F IO 2 table and the best-oxygenation strategies provided higher PEEP than the best-compliance strategy (11 ± 6 cm H 2 O vs. 11 ± 3 cm H 2 O vs. 6 ± 2 cm H 2 O, p = 0.001), leading to higher plateau pressure, driving pressure, and mechanical power. The three PEEP strategies were not significantly different in gas exchange. The subgroup analysis showed that three PEEP strategies generated different effects in subjects with moderate or severe ARDS ( n = 12) but not in subjects with mild ARDS ( n = 8). Conclusions: In our cohort with COVID-19–induced ARDS, the ARDSnet low PEEP/F IO 2 table and the best-oxygenation strategies led to higher PEEP and potentially higher risk of ventilator-induced lung injury than the best-compliance strategy. Clinical Trial Registration:www.ClinicalTrials.gov , identifier: {"type":"clinical-trial","attrs":{"text":"NCT04359251","term_id":"NCT04359251"}} NCT04359251 .

【 授权许可】

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