Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study
| Autor: | Robba, C., Ball, L., Battaglini, D., Cardim, D., Moncalvo, E., Brunetti, I., Bassetti, M., Giacobbe, D. R., Vena, A., Patroniti, N., Rocco, P. R. M., Matta, B. F., Pelosi, P., Anania, P., Berri, C., Ciaravolo, E., Dentone, C., Fiaschi, P., Frisoni, P., Gratarola, A., Magnasco, L., Marramao, F., Sottano, M., Taramasso, L., Tarantino, F., Zona, G. |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
ARDS Population Hemodynamics Critical Care and Intensive Care Medicine Recruitment maneuvers Rescue therapies 03 medical and health sciences Prone position 0302 clinical medicine Interquartile range medicine Humans Prospective Studies education Prospective cohort study Oxygen saturation (medicine) Aged Carbon dioxide removal Cerebral oxygenation Coronavirus COVID-19 Female Italy Middle Aged Oxygen Respiratory Distress Syndrome Treatment Outcome Cerebrovascular Circulation Respiration Artificial education.field_of_study business.industry Research Respiration lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Oxygenation medicine.disease Anesthesia Artificial Arterial blood business 030217 neurology & neurosurgery |
| Zdroj: | Critical Care Critical Care, Vol 25, Iss 1, Pp 1-13 (2021) |
| Popis: | BackgroundIn COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics.MethodsThis is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients.ResultsForty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2and PaCO2values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%,p 2(from 62 [56–71] to 82 [76–87] mmHg,p = 0.005) and rSO2(from 53 [52–54]% to 60 [59–64]%,p = 0.005). The use of iNO increased PaO2(from 65 [67–73] to 72 [67–73] mmHg,p = 0.015) and rSO2(from 53 [51–56]% to 57 [55–59]%,p = 0.007). The use of ECCO2R decreased PaO2(from 75 [75–79] to 64 [60–70] mmHg,p = 0.009), with reduction of rSO2values (59 [56–65]% vs. 56 [53–62]%,p = 0.002). In the whole population, a significant relationship was found between SpO2and rSO2(R = 0.62,p 2and rSO2(R0 0.54,p ConclusionsRescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs.RegistrationThe study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020). |
| Databáze: | OpenAIRE |
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