Respiratory failure & ventilation
Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients
Authors' conclusion
A PEEP adjustment procedure based on PEEP-induced changes in dPaw is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients.
Study context
- Population
- Mechanically ventilated patients with ARDS from COVID-19 in three hospitals41 with electrical impedance tomography (EIT)
- Participants
- 184 participants
- Exposure
- J-shaped vs U-shaped vs inverted-J
- J-shapedn = 126
- U-shapedn = 40
- inverted-Jn = 18
- Outcome
- dPaw vs PEEP curve behaviour (profile) and lowest PEEP minimizing dPaw (PEEPmin_dPaw), PEEP reduced from 20 to 6 cmH2O
Methodological detailsmulticentre, positive-end expiratory pressure (PEEP) decremental trial, electrical impedance tomography subset
- Multicentre
- PEEP decremental trial
- Electrical impedance tomography subset
Main finding
As reported in the abstract
dPaw vs PEEP profile and PEEPmin_dPaw
| Group | Value | PEEPmin_dPaw |
|---|---|---|
| J | 68% | 7.5 ± 1.9 cmH2O |
| U | 22% | 12.2 ± 2.6 cmH2O |
Value
J68%
U22%
PEEPmin_dPaw
J7.5 ± 1.9 cmH2O
U12.2 ± 2.6 cmH2O
Observational data: associations, not effects.
Further findings
Body mass index (BMI) and baseline PaO2/fraction of inspired oxygen (FiO2) by profile
- Inverted-J profiles had significantly higher BMI and lower baseline PaO2/FiO2 ratio
Alveolar collapse and hyperinflation (EIT)
- PEEPmin_dPaw associated with lower fractions of both alveolar collapse and hyperinflation
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients. Crit Care. Published 21 March 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →