Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome
Background: Different positive end-expiratory pressure (PEEP) strategies are available for subjects with coronavirus disease 2019 (COVID-19)–induced acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. We aimed to evaluate three conventional PEEP strategies on their...
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Frontiers Media S.A.
2021-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.637747/full |
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| author | Chun Pan Cong Lu Cong Lu Xiaobin She Haibo Ren Huazhang Wei Liang Xu Yingzi Huang Jia'an Xia Yuetian Yu Lu Chen Lu Chen Bin Du Haibo Qiu |
| author_facet | Chun Pan Cong Lu Cong Lu Xiaobin She Haibo Ren Huazhang Wei Liang Xu Yingzi Huang Jia'an Xia Yuetian Yu Lu Chen Lu Chen Bin Du Haibo Qiu |
| author_sort | Chun Pan |
| collection | DOAJ |
| description | Background: Different positive end-expiratory pressure (PEEP) strategies are available for subjects with coronavirus disease 2019 (COVID-19)–induced acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. We aimed to evaluate three conventional PEEP strategies on their effects on respiratory mechanics, gas exchanges, and hemodynamics.Methods: This is a prospective, physiologic, multicenter study conducted in China. We recruited 20 intubated subjects with ARDS and confirmed COVID-19. We first set PEEP by the ARDSnet low PEEP–fraction of inspired oxygen (FIO2) table. After a recruitment maneuver, PEEP was set at 15, 10, and 5 cm H2O for 10 min, respectively. Among these three PEEP levels, best-compliance PEEP was the one providing the highest respiratory system compliance; best-oxygenation PEEP was the one providing the highest PaO2 (partial pressure of arterial oxygen)/FIO2.Results: At each PEEP level, we assessed respiratory mechanics, arterial blood gas, and hemodynamics. Among three PEEP levels, plateau pressure, driving pressure, mechanical power, and blood pressure improved with lower PEEP. The ARDSnet low PEEP–FIO2 table and the best-oxygenation strategies provided higher PEEP than the best-compliance strategy (11 ± 6 cm H2O vs. 11 ± 3 cm H2O vs. 6 ± 2 cm H2O, p = 0.001), leading to higher plateau pressure, driving pressure, and mechanical power. The three PEEP strategies were not significantly different in gas exchange. The subgroup analysis showed that three PEEP strategies generated different effects in subjects with moderate or severe ARDS (n = 12) but not in subjects with mild ARDS (n = 8).Conclusions: In our cohort with COVID-19–induced ARDS, the ARDSnet low PEEP/FIO2 table and the best-oxygenation strategies led to higher PEEP and potentially higher risk of ventilator-induced lung injury than the best-compliance strategy.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04359251. |
| first_indexed | 2024-12-13T19:23:11Z |
| format | Article |
| id | doaj.art-51a5baaa1b7646b9aa1dfe9efcd6890d |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-13T19:23:11Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-51a5baaa1b7646b9aa1dfe9efcd6890d2022-12-21T23:34:07ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-07-01810.3389/fmed.2021.637747637747Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress SyndromeChun Pan0Cong Lu1Cong Lu2Xiaobin She3Haibo Ren4Huazhang Wei5Liang Xu6Yingzi Huang7Jia'an Xia8Yuetian Yu9Lu Chen10Lu Chen11Bin Du12Haibo Qiu13Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Critical Care, Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, CanadaInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, ChinaDepartment of Critical Care Medicine, Wuhan Asia General Hospital, Wuhan, ChinaDepartment of Critical Care Medicine, Jinggangshan University Affiliated Hospital, Jinggangshan, ChinaDepartment of Critical Care Medicine, Wuhan Wuchang Hospital, Wuhan, ChinaJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, ChinaDepartment of Critical Care Medicine, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care, Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, CanadaInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada0Medical Intensive Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, ChinaJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, ChinaBackground: Different positive end-expiratory pressure (PEEP) strategies are available for subjects with coronavirus disease 2019 (COVID-19)–induced acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. We aimed to evaluate three conventional PEEP strategies on their effects on respiratory mechanics, gas exchanges, and hemodynamics.Methods: This is a prospective, physiologic, multicenter study conducted in China. We recruited 20 intubated subjects with ARDS and confirmed COVID-19. We first set PEEP by the ARDSnet low PEEP–fraction of inspired oxygen (FIO2) table. After a recruitment maneuver, PEEP was set at 15, 10, and 5 cm H2O for 10 min, respectively. Among these three PEEP levels, best-compliance PEEP was the one providing the highest respiratory system compliance; best-oxygenation PEEP was the one providing the highest PaO2 (partial pressure of arterial oxygen)/FIO2.Results: At each PEEP level, we assessed respiratory mechanics, arterial blood gas, and hemodynamics. Among three PEEP levels, plateau pressure, driving pressure, mechanical power, and blood pressure improved with lower PEEP. The ARDSnet low PEEP–FIO2 table and the best-oxygenation strategies provided higher PEEP than the best-compliance strategy (11 ± 6 cm H2O vs. 11 ± 3 cm H2O vs. 6 ± 2 cm H2O, p = 0.001), leading to higher plateau pressure, driving pressure, and mechanical power. The three PEEP strategies were not significantly different in gas exchange. The subgroup analysis showed that three PEEP strategies generated different effects in subjects with moderate or severe ARDS (n = 12) but not in subjects with mild ARDS (n = 8).Conclusions: In our cohort with COVID-19–induced ARDS, the ARDSnet low PEEP/FIO2 table and the best-oxygenation strategies led to higher PEEP and potentially higher risk of ventilator-induced lung injury than the best-compliance strategy.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04359251.https://www.frontiersin.org/articles/10.3389/fmed.2021.637747/fullacute respiratory distress syndromecoronavirus disease 2019positive end-expiratory pressuremechanical ventilationlung injury |
| spellingShingle | Chun Pan Cong Lu Cong Lu Xiaobin She Haibo Ren Huazhang Wei Liang Xu Yingzi Huang Jia'an Xia Yuetian Yu Lu Chen Lu Chen Bin Du Haibo Qiu Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome Frontiers in Medicine acute respiratory distress syndrome coronavirus disease 2019 positive end-expiratory pressure mechanical ventilation lung injury |
| title | Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome |
| title_full | Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome |
| title_fullStr | Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome |
| title_short | Evaluation of Positive End-Expiratory Pressure Strategies in Patients With Coronavirus Disease 2019–Induced Acute Respiratory Distress Syndrome |
| title_sort | evaluation of positive end expiratory pressure strategies in patients with coronavirus disease 2019 induced acute respiratory distress syndrome |
| topic | acute respiratory distress syndrome coronavirus disease 2019 positive end-expiratory pressure mechanical ventilation lung injury |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.637747/full |
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