Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation and hemodynamics in pa
- PDF / 539,032 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 78 Downloads / 186 Views
RESEARCH LETTER
Open Access
Effect of PEEP decremental on respiratory mechanics, gasses exchanges, pulmonary regional ventilation, and hemodynamics in patients with SARS-Cov-2-associated acute respiratory distress syndrome Vincent Bonny1,2*, Vincent Janiak3,4, Savino Spadaro5,6, Andrea Pinna3, Alexandre Demoule1,2,7 and Martin Dres1,2,7 To the editor: Previous reports of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2)-related acute respiratory distress syndrome (ARDS) have been highlighting a profound hypoxemia and it is not yet well defined how to set positive end-expiratory pressure (PEEP) in this context [1]. In this report, we describe the effects of two levels of PEEP on lung mechanics using a multimodal approach. Patients with confirmed laboratory SARS-Cov-2 infection and meeting criteria for ARDS according to the Berlin definition [2] were eligible within the 48 h after intubation. Written informed consent was waived due to the observational nature of the study. The local ethic approved the study (N° CER-2020-16). Patients were paralyzed and received lung protective ventilation on volume-controlled ventilation. Effects of PEEP decremental were evaluated at two levels of PEEP, arbitrarily 16 cm H2O and 8 cm H2O. These levels were decided based on previous reports [3, 4]. Measurements were performed after 20 min after changing the level of PEEP. Lung mechanics were assessed using an esophageal catheter (NutriVentTM, Italy) [5]. Hemodynamics, indexed extravascular lung water (EVLWi), pulmonary * Correspondence: [email protected] 1 Neurophysiologie respiratoire expérimentale et clinique, UMRS1158, INSERM, Sorbonne Université, Paris, France 2 Service de Pneumologie, Médecine intensive Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l’Hôpital, 75651 Paris Cedex 13, France Full list of author information is available at the end of the article
vascular permeability index (PVPI), and cardiac function index (CFI) were monitored by transpulmonary thermodilution (TPTD) device (PiCCO2, Pulsion Medical Systems, Germany). Pulmonary regional ventilation was monitored by the use of an EIT belt placed around the patient’s chest (PulmoVista500; Dräger Medical GmbH Lübeck, Germany) [6]. Ten patients were enrolled and the effects of two levels of PEEP decremental are displayed in Table 1. The PEEP decremental significantly increased both cardiac index and cardiac function index but did not significantly influence other TPTD-related variables. PEEP decremental was not associated with significant changes in gasses exchanges but was associated with a significant decrease in plateau pressure and driving pressure and with a significant decrease in end-inspiratory and in end-expiratory transpulmonary pressures. Lung compliance was significantly higher at low PEEP. Regarding pulmonary regional ventilation, PEEP decremental resulted in a loss of lung impedance associated with a decrease in dorsal fraction. By contrast, decreasing PEEP did not affect global inhomogeneity index. Best PEEP according t
Data Loading...
