Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome
RATIONALE: Patients with coronavirus disease-19-related acute respiratory distress syndrome (C-ARDS) could have a specific physiological phenotype as compared with those affected by ARDS from other causes (NC-ARDS).
OBJECTIVES: To describe the effect of positive end-expiratory pressure (PEEP) on respiratory mechanics in C-ARDS patients in supine and prone position, and as compared to NC-ARDS. The primary endpoint was the best PEEP defined as the smallest sum of hyperdistension and collapse.
METHODS: Seventeen patients with moderate-to-severe C-ARDS were monitored by electrical impedance tomography (EIT) and evaluated during PEEP titration in supine (n = 17) and prone (n = 14) position and compared with 13 NC-ARDS patients investigated by EIT in our department before the COVID-19 pandemic.
RESULTS: As compared with NC-ARDS, C-ARDS exhibited a higher median best PEEP (defined using EIT as the smallest sum of hyperdistension and collapse, 12 [9, 12] vs. 9 [6, 9] cmH2O, p < 0.01), more collapse at low PEEP, and less hyperdistension at high PEEP. The median value of the best PEEP was similar in C-ARDS in supine and prone position: 12 [9, 12] vs. 12 [10, 15] cmH2O, p = 0.59. The response to PEEP was also similar in C-ARDS patients with higher vs. lower respiratory system compliance.
CONCLUSION: An intermediate PEEP level seems appropriate in half of our C-ARDS patients. There is no solid evidence that compliance at low PEEP could predict the response to PEEP.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Critical care (London, England) - 24(2020), 1 vom: 07. Dez., Seite 678 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Perier, François [VerfasserIn] |
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| Links: |
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| Themen: |
ARDS |
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| Anmerkungen: |
Date Completed 31.12.2020 Date Revised 31.12.2020 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-020-03414-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318536692 |
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| 100 | 1 | |a Perier, François |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 31.12.2020 | ||
| 500 | |a Date Revised 31.12.2020 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a RATIONALE: Patients with coronavirus disease-19-related acute respiratory distress syndrome (C-ARDS) could have a specific physiological phenotype as compared with those affected by ARDS from other causes (NC-ARDS) | ||
| 520 | |a OBJECTIVES: To describe the effect of positive end-expiratory pressure (PEEP) on respiratory mechanics in C-ARDS patients in supine and prone position, and as compared to NC-ARDS. The primary endpoint was the best PEEP defined as the smallest sum of hyperdistension and collapse | ||
| 520 | |a METHODS: Seventeen patients with moderate-to-severe C-ARDS were monitored by electrical impedance tomography (EIT) and evaluated during PEEP titration in supine (n = 17) and prone (n = 14) position and compared with 13 NC-ARDS patients investigated by EIT in our department before the COVID-19 pandemic | ||
| 520 | |a RESULTS: As compared with NC-ARDS, C-ARDS exhibited a higher median best PEEP (defined using EIT as the smallest sum of hyperdistension and collapse, 12 [9, 12] vs. 9 [6, 9] cmH2O, p < 0.01), more collapse at low PEEP, and less hyperdistension at high PEEP. The median value of the best PEEP was similar in C-ARDS in supine and prone position: 12 [9, 12] vs. 12 [10, 15] cmH2O, p = 0.59. The response to PEEP was also similar in C-ARDS patients with higher vs. lower respiratory system compliance | ||
| 520 | |a CONCLUSION: An intermediate PEEP level seems appropriate in half of our C-ARDS patients. There is no solid evidence that compliance at low PEEP could predict the response to PEEP | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Electrical impedance tomography | |
| 650 | 4 | |a Mechanical ventilation | |
| 650 | 4 | |a PEEP | |
| 700 | 1 | |a Tuffet, Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Maraffi, Tommaso |e verfasserin |4 aut | |
| 700 | 1 | |a Alcala, Glasiele |e verfasserin |4 aut | |
| 700 | 1 | |a Victor, Marcus |e verfasserin |4 aut | |
| 700 | 1 | |a Haudebourg, Anne-Fleur |e verfasserin |4 aut | |
| 700 | 1 | |a Razazi, Keyvan |e verfasserin |4 aut | |
| 700 | 1 | |a De Prost, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Amato, Marcelo |e verfasserin |4 aut | |
| 700 | 1 | |a Carteaux, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Mekontso Dessap, Armand |e verfasserin |4 aut | |
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