Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach?
Background Acute respiratory failure (ARF) is a life-threatening complication in patients with community acquired pneumonia (CAP). The use of non-invasive ventilation is controversial. With this prospective, observational study we aimed to describe a protocol to assess whether a patient with moderat...
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PeerJ Inc.
2018-01-01
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| author | Valentina Paolini Paola Faverio Stefano Aliberti Grazia Messinesi Giuseppe Foti Oriol Sibila Anna Monzani Federica De Giacomi Anna Stainer Alberto Pesci |
| author_facet | Valentina Paolini Paola Faverio Stefano Aliberti Grazia Messinesi Giuseppe Foti Oriol Sibila Anna Monzani Federica De Giacomi Anna Stainer Alberto Pesci |
| author_sort | Valentina Paolini |
| collection | DOAJ |
| description | Background Acute respiratory failure (ARF) is a life-threatening complication in patients with community acquired pneumonia (CAP). The use of non-invasive ventilation is controversial. With this prospective, observational study we aimed to describe a protocol to assess whether a patient with moderate-to-severe hypoxemic ARF secondary to CAP benefits, in clinical and laboratoristic terms, from the application of a positive end expiratory pressure (PEEP) + oxygen vs oxygen alone. Methods Patients who benefit from PEEP application (PEEP-responders) were defined as those with partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) increase >20% and/or reduction of respiratory distress during PEEP + oxygen therapy compared to oxygen therapy alone. Clinical characteristics and outcomes were compared between PEEP-responders and PEEP-non responders. Results Out of 41 patients, 27 (66%) benefit from PEEP application (PEEP-responders), the best response was obtained with a PEEP of 10 cmH2O in 13 patients, 7.5 cmH2O in eight and 5 cmH2O in six. PEEP-responders were less likely to present comorbidities compared to PEEP-non responders. No differences between groups were found in regards to endotracheal intubation criteria fullfillment, intensive care unit admission and in-hospital mortality, while PEEP-responders had a shorter length of hospital stay. Discussion The application of a protocol to evaluate PEEP responsiveness might be useful in patients with moderate-to-severe hypoxemic ARF due to CAP in order to personalize and maximize the effectiveness of therapy, and prevent the inappropriate PEEP use. PEEP responsiveness does not seem to be associated with better outcomes, with the exception of a shorter length of hospital stay. |
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| language | English |
| last_indexed | 2024-03-09T06:48:36Z |
| publishDate | 2018-01-01 |
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| spelling | doaj.art-c82bc13d4ddf4b219b6d848f1654b0f02023-12-03T10:31:39ZengPeerJ Inc.PeerJ2167-83592018-01-016e421110.7717/peerj.4211Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach?Valentina Paolini0Paola Faverio1Stefano Aliberti2Grazia Messinesi3Giuseppe Foti4Oriol Sibila5Anna Monzani6Federica De Giacomi7Anna Stainer8Alberto Pesci9Dipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDepartment of Pathophysiology and Transplantation, Cardio-thoracic unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milano, ItalyDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDepartment of Anesthesia and Intensive Care, San Gerardo Hospital, ASST-Monza, University of Milan— Bicocca, Monza, ItalyRespiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona (UAB), and Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, SpainDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyDipartimento Cardio-Toraco-Vascolare, Respiratory Unit, San Gerardo Hospital, ASST di Monza, University of Milan—Bicocca, Monza, ItalyBackground Acute respiratory failure (ARF) is a life-threatening complication in patients with community acquired pneumonia (CAP). The use of non-invasive ventilation is controversial. With this prospective, observational study we aimed to describe a protocol to assess whether a patient with moderate-to-severe hypoxemic ARF secondary to CAP benefits, in clinical and laboratoristic terms, from the application of a positive end expiratory pressure (PEEP) + oxygen vs oxygen alone. Methods Patients who benefit from PEEP application (PEEP-responders) were defined as those with partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) increase >20% and/or reduction of respiratory distress during PEEP + oxygen therapy compared to oxygen therapy alone. Clinical characteristics and outcomes were compared between PEEP-responders and PEEP-non responders. Results Out of 41 patients, 27 (66%) benefit from PEEP application (PEEP-responders), the best response was obtained with a PEEP of 10 cmH2O in 13 patients, 7.5 cmH2O in eight and 5 cmH2O in six. PEEP-responders were less likely to present comorbidities compared to PEEP-non responders. No differences between groups were found in regards to endotracheal intubation criteria fullfillment, intensive care unit admission and in-hospital mortality, while PEEP-responders had a shorter length of hospital stay. Discussion The application of a protocol to evaluate PEEP responsiveness might be useful in patients with moderate-to-severe hypoxemic ARF due to CAP in order to personalize and maximize the effectiveness of therapy, and prevent the inappropriate PEEP use. PEEP responsiveness does not seem to be associated with better outcomes, with the exception of a shorter length of hospital stay.https://peerj.com/articles/4211.pdfPneumoniaRespiratory failureContinuous positive airway pressurePositive end-expiratory pressureNon-invasive ventilation |
| spellingShingle | Valentina Paolini Paola Faverio Stefano Aliberti Grazia Messinesi Giuseppe Foti Oriol Sibila Anna Monzani Federica De Giacomi Anna Stainer Alberto Pesci Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? PeerJ Pneumonia Respiratory failure Continuous positive airway pressure Positive end-expiratory pressure Non-invasive ventilation |
| title | Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? |
| title_full | Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? |
| title_fullStr | Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? |
| title_full_unstemmed | Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? |
| title_short | Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? |
| title_sort | positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia do we need a personalized approach |
| topic | Pneumonia Respiratory failure Continuous positive airway pressure Positive end-expiratory pressure Non-invasive ventilation |
| url | https://peerj.com/articles/4211.pdf |
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