Lung response to a higher positive end-expiratory pressure in mechanically ventilated patients with COVID-19
| Autor: | Giorgio Picardo, Massimo Cressoni, Michele Ferrari, Ezio Lanza, Chiara Chiurazzi, Alessandro Protti, Andrea Aliverti, Luca Carenzo, Francesca Pennati, Pietro Caironi, Alessandro Santini, Maurizio Cecconi, G. Iapichino |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
ARDS Supine position medicine.medical_treatment PEEP positive end-expiratory pressure mechanical ventilation Critical Care and Intensive Care Medicine Positive-Pressure Respiration coronavirus disease 2019 FiO2 fraction of inspired oxygen Fraction of inspired oxygen medicine Humans Q3 third quartile Lung Positive end-expiratory pressure ARDS acute respiratory distress syndrome Original Research COVID-19 coronavirus disease 2019 Mechanical ventilation Q1 first quartile COPD Respiratory Distress Syndrome business.industry Respiration COVID-19 Oxygenation respiratory system acute respiratory distress syndrome PaO2 arterial oxygen tension medicine.disease ICU intensive care unit Respiration Artificial respiratory tract diseases CT computed tomography medicine.anatomical_structure COPD chronic obstructive pulmonary disease Anesthesia Artificial PaCO2 arterial carbon dioxide tension Cardiology and Cardiovascular Medicine business circulatory and respiratory physiology positive end-expiratory pressure |
| Zdroj: | Chest |
| ISSN: | 1931-3543 0012-3692 |
| Popis: | Background International guidelines suggest using a higher (>10 cmH2O) positive end-expiratory pressure (PEEP) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) due to the novel coronavirus disease (COVID-19). However, even if oxygenation generally improves with a higher PEEP, compliance and arterial carbon dioxide tension (PaCO2) frequently do not, as if recruitment was small. Research question Is the potential for lung recruitment small in patients with early ARDS due to COVID-19? Study design and methods Forty patients with ARDS due to COVID-19 were studied in the supine position within three days of endotracheal intubation. They all underwent a PEEP trial, where oxygenation, compliance, and PaCO2 were measured with 5, 10, and 15 cmH2O of PEEP and all other ventilatory settings unchanged. Twenty underwent a whole-lung static computed tomography at 5 and 45 cmH2O, and the other twenty at 5 and 15 cmH2O of airway pressure. Recruitment and hyperinflation were defined as a decrease in the volume of the non-aerated (density above -100 HU) and an increase in the volume of the over-aerated (density below -900 HU) lung compartments, respectively. Results From 5 to 15 cmH2O, oxygenation improved in thirty-six (90%) patients but compliance only in eleven (28%) and PaCO2 only in fourteen (35%). From 5 to 45 cmH2O, recruitment was 351 (161-462) ml and hyperinflation 465 (220-681) ml. From 5 to 15 cmH2O, recruitment was 168 (110-202) ml and hyperinflation 121 (63-270) ml. Hyperinflation variably developed in all patients and exceeded recruitment in more than half of them. Interpretation Patients with early ARDS due to COVID-19, ventilated in the supine position, present with a large potential for lung recruitment. Even so, their compliance and PaCO2 do not generally improve with a higher PEEP, possibly due to hyperinflation. |
| Databáze: | OpenAIRE |
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