Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study

Taenaka, H; Yoshida, T; Hashimoto, H; Firstiogusran, AMF; Ishigaki, S; Iwata, H; Enokidani, Y; Ebishima, H; Kubo, N; Koide, M; Koyama, Y; Sakaguchi, R; Tokuhira, N; Horiguchi, Y; Uchiyama, A; Fujino, Y

doi:10.1186/s13054-023-04360-6

Respiratory failure & ventilation

Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study

Crit CarePublished 19 Apr 2023Prospective clinical physiological study

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Authors' conclusion

Higher PEEP in prone position and lower PEEP in prone position decreased the amount of dependent silent spaces (suggesting lung collapse) without increasing the amount of non-dependent silent spaces (suggesting overinflation) in high recruiter and in low recruiter, respectively.

Study context

Population: Patients with COVID-19-associated ARDS
Participants: 43 patients

Exposure: Positive end-expiratory pressure (PEEP) in supine and prone position, by lung recruitability
Outcome: Recruitment-to-inflation ratio; oxygenation and regional lung inflation (EIT) by PEEP and position

Methodological detailsconsecutive enrolment, electrical impedance tomography

Consecutive enrolment
Electrical impedance tomography

Main finding

As reported in the abstract

Recruitment-to-inflation ratio (median, IQR 0.52-0.84), separating high vs low recruiter

0.68

Observational data: associations, not effects.

Reference

Authors: Taenaka H, Yoshida T, Hashimoto H, Firstiogusran AMF, Ishigaki S, Iwata H, et al.
All 16 authors
Taenaka H, Yoshida T, Hashimoto H, Firstiogusran AMF, Ishigaki S, Iwata H, Enokidani Y, Ebishima H, Kubo N, Koide M, Koyama Y, Sakaguchi R, Tokuhira N, Horiguchi Y, Uchiyama A, Fujino Y
Journal: Critical Care
Published: 19 Apr 2023
DOI: 10.1186/s13054-023-04360-6
PubMed: 37076900

Topic: Respiratory failure & ventilation

Exposure

PEEP (low 5 vs high 15 cmH2O) in supine and prone position, by lung recruitability (recruitment-to-inflation ratio)

Exposure definitions

High recruiter: recruitment-to-inflation ratio above 0.68
Low recruiter: recruitment-to-inflation ratio below 0.68

Key notes

Oxygenation the same between high and low recruiters
High recruiter: high PEEP + prone gave highest oxygenation and less dependent silent spaces (vs low PEEP in both positions) without increasing non-dependent silent spaces

More notes

Low recruiter: low PEEP + prone gave better oxygenation (vs both PEEPs supine), less dependent silent spaces (vs low PEEP supine) and less non-dependent silent spaces (vs high PEEP in both positions)
With high PEEP, recruitment-to-inflation ratio positively correlated with improvement in oxygenation and respiratory system compliance and decrease in dependent silent spaces, inversely with increase in non-dependent silent spaces

Original publication

Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study. Crit Care. Published 19 April 2023. doi:10.1186/s13054-023-04360-6

Read the original article ↗

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