by Peter Somhorst, Philip van der Zee, Henrik Endeman and
Diederik Gommers
Critical Care volume 26,
Article number: 272 (2022)
Rationale
It is unknown how to titrate positive end-expiratory
pressure (PEEP) in patients with COVID-19-related acute respiratory distress
syndrome (ARDS). Guidelines recommend the one-size-fits-all PEEP-FiO2 table.
In this retrospective cohort study, an electrical impedance tomography
(EIT)-guided PEEP trial was used to titrate PEEP.
Objectives
To compare baseline PEEP according to the high PEEP-FiO2 table
and personalized PEEP following an EIT-guided PEEP trial.
Methods
We performed an EIT-guided decremental PEEP trial in
patients with moderate-to-severe COVID-19-related ARDS upon intensive care unit
admission. PEEP was set at the lowest PEEP above the intersection of curves
representing relative alveolar overdistention and collapse. Baseline PEEP was
compared with PEEP set according to EIT. We identified patients in whom the
EIT-guided PEEP trial resulted in a decrease or increase in PEEP of ≥ 2 cmH2O.
Measurements and main results
We performed a PEEP trial in 75 patients. In 23 (31%)
patients, PEEP was decreased ≥ 2 cmH2O, and in 24 (32%) patients, PEEP was
increased ≥ 2 cmH2O. Patients in whom PEEP was decreased had improved
respiratory mechanics and more overdistention in the non-dependent lung region
at higher PEEP levels. These patients also had a lower BMI, longer time between
onset of symptoms and intubation, and higher incidence of pulmonary embolism.
Oxygenation improved in patients in whom PEEP was increased.
Conclusions
An EIT-guided PEEP trial resulted in a relevant change in
PEEP in 63% of patients. These results support the hypothesis that PEEP should
be personalized in patients with ARDS.
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