High PEEP/low FiO 2 ventilation is associated with lower mortality in COVID-19.

Autor: Goossen RL; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands. Electronic address: r.l.goossen@amsterdamumc.nl., van Vliet R; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Bos LDJ; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Buiteman-Kruizinga LA; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands., Hollman MW; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Myatra SN; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India., Neto AS; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil., Spronk PE; Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands., van der Woude MCE; Department of Intensive Care, Heerlen Medical Center, Heerlen, the Netherlands., van Meenen DMP; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Paulus F; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Faculty of Health, ACHIEVE, center of applied research, University of Applied Research, Amsterdam, the Netherlands., Schultz MJ; Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2024 Oct; Vol. 83, pp. 154854. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1016/j.jcrc.2024.154854
Abstrakt: Rationale: The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO 2 ventilation on outcomes during the second wave in the Netherlands.
Methods: Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality.
Results: This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings.
Conclusions: High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: