Other bulletins in this series include:

Breast Surgery

Tuesday 19 May 2020

Letter: Advanced respiratory monitoring in COVID-19 patients: use less PEEP!


by Lisanne Roesthuis, Maarten van den Berg and Hans van der Hoeven

Critical Care volume 24, Article number: 230 (2020) Published: 15 May 2020

In the majority of coronavirus disease 2019 (COVID-19) patients, respiratory mechanics is different from the “normal” acute respiratory distress syndrome (ARDS) patient. Plateau pressures and driving pressures are often low and respiratory system compliance relatively normal compared to the ARDS patient [1]. Many physicians use high positive end-expiratory pressure (PEEP) for patients with COVID-19 although the potential for recruitment is often low [12]. We fear that the high compliance of the respiratory system in combination with high PEEP will lead to hyperinflation, high dead space, and potentially right ventricular failure.

We have used the following strategy for COVID-19 patients (N = 70): after intubation, immediately prone positioning for at least 3 days, using the lowest possible PEEP to obtain adequate oxygenation with FiO2 of 50%. We assessed the effects of different PEEP levels on respiratory mechanics and ventilation-perfusion mismatching.

No comments: