Optimal Positive End-expiratory Pressure Levels in Tuberculosis-associated Acute Respiratory Distress Syndrome

Autor: Seyed MohammadReza Hashemian, Batoul Khoundabi, Ashkan Bahrami, Hamidreza Jamaati, Mohammad Varahram, Leila Saljoughi, Payam Rahimi, Reza Eshraghi
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: International Journal of Mycobacteriology, Vol 13, Iss 3, Pp 247-251 (2024)
Druh dokumentu: article
ISSN: 2212-5531
2212-554X
DOI: 10.4103/ijmy.ijmy_136_24
Popis: Background: The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients. Methods: This observational case–control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level. Results: Delta impedance values showed higher amounts in a PEEP range of 11–17 cm H2O and in patients with TB-ARDS (P > 0.05). In addition, both hyperdistention and collapse rates were nonsignificantly higher in TB-ARDS patients (P > 0.05), and the compromised levels of hyperdistention and collapse rates were at 15–17 cm H2O, indicating the most favorable PEEP level. Conclusions: The observed patterns of hyperdistention and collapse rates across various PEEP levels provide valuable insights into the susceptibility of TB-ARDS patients to barotrauma. Notably, the identified optimal PEEP range between 15 and 17 cm H2O may guide ventilator management strategies in mitigating both hyperdistention and collapse; nonetheless, due to the high variability of lung compliances within groups, we strongly recommend individualized consideration for tailored respiratory support and evaluation.
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