Response to PEEP in COVID-19 ARDS patients with and without extracorporeal membrane oxygenation. A multicenter case–control computed tomography study

Critical Care

Gilbert Ferretti¹  Loic Boussel²  Eduardo Davila²  Emmanuel Roux²  Maciej Orkisz²  Matteo Pozzi³  Laurent Bitker⁴  William Danjou⁴  Maxime Gaillet⁴  Alwin Bazzani⁴  Mehdi Girard⁴  Francois Dhelft⁴  Hodane Yonis⁴  Laure Folliet⁴  Jean-Christophe Richard⁴  Mehdi Mezidi⁴  Florian Sigaud⁵  Nicolas Terzi⁵  Touria Ahaouari⁶  Sam Bayat⁶ 

[1] Grenoble, France Service de Radiologie Diagnostique Et Interventionnelle, Université Grenoble Alpes, CHU Grenoble-Alpes;INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, Univ Lyon, Université Claude Bernard Lyon 1;Service de Chirurgie Cardiaque, Hôpital Louis Pradel;Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon;Service de Médecine-Intensive Réanimation, CHU Grenoble-Alpes;Synchrotron Radiation for Biomedicine Laboratory (STROBE), INSERM UA07, Univ. Grenoble Alpes;

关键词: ARDS;    Computed tomography;    ECMO;    PEEP;    COVID-19;   

DOI  :  10.1186/s13054-022-04076-z

来源: DOAJ

【 摘 要 】

Abstract Background PEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT). Methods We conducted a two-center prospective observational case–control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72  h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS. Results Non-inflated lung at PEEP 5 cmH2O was significantly greater in ECMO than in non-ECMO patients. Recruitment induced by increasing PEEP from 5 to 15 cmH2O was not significantly different between ECMO and non-ECMO patients, while PEEP-induced hyperinflation was significantly lower in the ECMO group and virtually nonexistent. The median [IQR] fraction of recruitable lung mass between PEEP 5 and 15 cmH2O was 6 [4–10]%. Total superimposed pressure at PEEP 5 cmH2O was significantly higher in ECMO patients and amounted to 12 [11–13] cmH2O. The hyperinflation-to-recruitment ratio (i.e., a trade-off index of the adverse effects and benefits of PEEP) was significantly lower in ECMO patients and was lower than one in 23 (96%) ECMO patients, 41 (69%) severe non-ECMO patients and 8 (50%) moderate ARDS patients. Compliance of the aerated lung at PEEP 5 cmH2O corrected for PEEP-induced recruitment (CBABY LUNG) was significantly lower in ECMO patients than in non-ECMO patients and was linearly related to the logarithm of the hyperinflation-to-recruitment ratio. Conclusions Lung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH2O appears favorable in virtually all ECMO patients, while this PEEP level is required to counteract compressive forces leading to lung collapse. CBABY LUNG is significantly lower in ECMO patients, independently of lung recruitability.

【 授权许可】

Unknown