tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2021 Dec 22;8:720920.
doi: 10.3389/fmed.2021.720920. eCollection 2021.
Positive End-Expiratory Pressure Setting in COVID-19-Related Acute Respiratory Distress Syndrome: Comparison Between Electrical Impedance Tomography, PEEP/FiO [SUB]2[/SUB] Tables, and Transpulmonary Pressure
Sébastien Gibot[SUP] 1 [/SUP], Marie Conrad[SUP] 1 [/SUP], Guilhem Courte[SUP] 1 [/SUP], Aurélie Cravoisy[SUP] 1 [/SUP]
Affiliations
Abstract
Introduction: The best way to titrate the positive end-expiratory pressure (PEEP) in patients suffering from acute respiratory distress syndrome is still matter of debate. Electrical impedance tomography (EIT) is a non-invasive technique that could guide PEEP setting based on an optimized ventilation homogeneity. Methods: For this study, we enrolled the patients with 2019 coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS), who required mechanical ventilation and were admitted to the ICU in March 2021. Patients were monitored by an esophageal catheter and a 32-electrode EIT device. Within 48 h after the start of mechanical ventilation, different levels of PEEP were applied based upon PEEP/FiO[SUB]2[/SUB] tables, positive end-expiratory transpulmonary (P[SUB]L[/SUB])/ FiO2 table, and EIT. Respiratory mechanics variables were recorded. Results: Seventeen patients were enrolled. PEEP values derived from EIT (PEEP[SUB]EIT[/SUB]) were different from those based upon other techniques and has poor in-between agreement. The PEEP[SUB]EIT[/SUB] was associated with lower plateau pressure, mechanical power, transpulmonary pressures, and with a higher static compliance (Crs) and homogeneity of ventilation. Conclusion: Personalized PEEP setting derived from EIT may help to achieve a more homogenous distribution of ventilation. Whether this approach may translate in outcome improvement remains to be investigated.
Keywords: ARDS; COVID-19; PEEP; electrical tomography impedance; mechanical ventilation.
. 2021 Dec 22;8:720920.
doi: 10.3389/fmed.2021.720920. eCollection 2021.
Positive End-Expiratory Pressure Setting in COVID-19-Related Acute Respiratory Distress Syndrome: Comparison Between Electrical Impedance Tomography, PEEP/FiO [SUB]2[/SUB] Tables, and Transpulmonary Pressure
Sébastien Gibot[SUP] 1 [/SUP], Marie Conrad[SUP] 1 [/SUP], Guilhem Courte[SUP] 1 [/SUP], Aurélie Cravoisy[SUP] 1 [/SUP]
Affiliations
- PMID: 35004712
- PMCID: PMC8727370
- DOI: 10.3389/fmed.2021.720920
Abstract
Introduction: The best way to titrate the positive end-expiratory pressure (PEEP) in patients suffering from acute respiratory distress syndrome is still matter of debate. Electrical impedance tomography (EIT) is a non-invasive technique that could guide PEEP setting based on an optimized ventilation homogeneity. Methods: For this study, we enrolled the patients with 2019 coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS), who required mechanical ventilation and were admitted to the ICU in March 2021. Patients were monitored by an esophageal catheter and a 32-electrode EIT device. Within 48 h after the start of mechanical ventilation, different levels of PEEP were applied based upon PEEP/FiO[SUB]2[/SUB] tables, positive end-expiratory transpulmonary (P[SUB]L[/SUB])/ FiO2 table, and EIT. Respiratory mechanics variables were recorded. Results: Seventeen patients were enrolled. PEEP values derived from EIT (PEEP[SUB]EIT[/SUB]) were different from those based upon other techniques and has poor in-between agreement. The PEEP[SUB]EIT[/SUB] was associated with lower plateau pressure, mechanical power, transpulmonary pressures, and with a higher static compliance (Crs) and homogeneity of ventilation. Conclusion: Personalized PEEP setting derived from EIT may help to achieve a more homogenous distribution of ventilation. Whether this approach may translate in outcome improvement remains to be investigated.
Keywords: ARDS; COVID-19; PEEP; electrical tomography impedance; mechanical ventilation.