by Lisanne Roesthuis, Maarten van den Berg and Hans van der
Hoeven
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 [1, 2]. 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.
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