Lung response to a higher positive end-expiratory pressure in mechanically ventilated patients with COVID-19

Chest. 2021 Oct 16:S0012-3692(21)04100-3. doi: 10.1016/j.chest.2021.10.012. Online ahead of print.ABSTRACTBACKGROUND: International guidelines suggest using a higher (>10 cmH2O) positive end-expiratory pressure (PEEP) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) due to the novel coronavirus disease (COVID-19). However, even if oxygenation generally improves with a higher PEEP, compliance and arterial carbon dioxide tension (PaCO2) frequently do not, as if recruitment was small.RESEARCH QUESTION: Is the potential for lung recruitment small in patients with early ARDS due to COVID-19?STUDY DESIGN AND METHODS: Forty patients with ARDS due to COVID-19 were studied in the supine position within three days of endotracheal intubation. They all underwent a PEEP trial, where oxygenation, compliance, and PaCO2 were measured with 5, 10, and 15 cmH2O of PEEP and all other ventilatory settings unchanged. Twenty underwent a whole-lung static computed tomography at 5 and 45 cmH2O, and the other twenty at 5 and 15 cmH2O of airway pressure. Recruitment and hyperinflation were defined as a decrease in the volume of the non-aerated (density above -100 HU) and an increase in the volume of the over-aerated (density below -900 HU) lung compartments, respectively.RESULTS: From 5 to 15 cmH2O, oxygenation improved in thirty-six (90%) patients but compliance only in eleven (28%) and PaCO2 only in fourteen (35%). From 5 to 45 cmH2O, recruitment was 351 (161-462) ml ...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research