Low PEEP Mechanical Ventilation and PaO 2 /FiO 2 Ratio Evolution in COVID-19 Patients.

Autor: Ceruti S; Department of Critical Care, Clinica Luganese Moncucco, Lugano, Switzerland., Roncador M; Internal Medicine Service, Clinica Luganese Moncucco, Lugano, Switzerland.; Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland., Saporito A; Anesthesiology Division, Ospedale Regionale di Bellinzona e Valli, 6500 Bellinzona, Switzerland., Biggiogero M; Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Switzerland., Glotta A; Department of Critical Care, Clinica Luganese Moncucco, Lugano, Switzerland., Maida PA; Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Switzerland., Urso P; Radiotherapy Department, Clinica Luganese Moncucco, Lugano, Switzerland., Bona G; Internal Medicine Service, Clinica Luganese Moncucco, Lugano, Switzerland., Garzoni C; Internal Medicine Service, Clinica Luganese Moncucco, Lugano, Switzerland., Mauri R; Department of Critical Care, Clinica Luganese Moncucco, Lugano, Switzerland., Borgeat A; Anaesthesiology Division, Balgrist University Hospital, Zürich, Switzerland.
Jazyk: angličtina
Zdroj: SN comprehensive clinical medicine [SN Compr Clin Med] 2021; Vol. 3 (12), pp. 2435-2442. Date of Electronic Publication: 2021 Jul 24.
DOI: 10.1007/s42399-021-01031-x
Abstrakt: Invasive mechanical ventilation (IMV) is the standard treatment in critically ill COVID-19 patients with acute severe respiratory distress syndrome (ARDS). When IMV setting is extremely aggressive, especially through the application of high positive-end-expiratory respiration (PEEP) values, lung damage can occur. Until today, in COVID-19 patients, two types of ARDS were identified (L- and H-type); for the L-type, a lower PEEP strategy was supposed to be preferred, but data are still missing. The aim of this study was to evaluate if a clinical management with lower PEEP values in critically ill L-type COVID-19 patients was safe and efficient in comparison to usual standard of care. A retrospective analysis was conducted on consecutive patients with COVID-19 ARDS admitted to the ICU and treated with IMV. Patients were treated with a lower PEEP strategy adapted to BMI: PEEP 10 cmH 2 O if BMI < 30 kg m -2 , PEEP 12 cmH 2 O if BMI 30-50 kg m -2 , PEEP 15 cmH 2 O if BMI > 50 kg m -2 . Primary endpoint was the PaO 2 /FiO 2 ratio evolution during the first 3 IMV days; secondary endpoints were to analyze ICU length of stay (LOS) and IMV length. From March 2 to January 15, 2021, 79 patients underwent IMV. Average applied PEEP was 11 ± 2.9 cmH 2 O for BMI < 30 kg m -2 and 16 ± 3.18 cmH 2 O for BMI > 30 kg m -2 . During the first 24 h of IMV, patients' PaO 2 /FiO 2 ratio presented an improvement ( p <0.001; CI 99%) that continued daily up to 72 h ( p <0.001; CI 99%). Median ICU LOS was 15 days (10-28); median duration of IMV was 12 days (8-26). The ICU mortality rate was 31.6%. Lower PEEP strategy treatment in L-type COVID-19 ARDS resulted in a PaO 2 /FiO 2 ratio persistent daily improvement during the first 72 h of IMV. A lower PEEP strategy could be beneficial in the first phase of ARDS in critically ill COVID-19 patients.
Competing Interests: Conflict of InterestThe authors declare no competing interests.
(© The Author(s) 2021.)
Databáze: MEDLINE
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