Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndr
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RESEARCH
Electrical impedance tomography to titrate positive end‑expiratory pressure in COVID‑19 acute respiratory distress syndrome François Perier1,2*† , Samuel Tuffet1,2†, Tommaso Maraffi1,3, Glasiele Alcala4, Marcus Victor4, Anne‑Fleur Haudebourg1,2, Keyvan Razazi1,2, Nicolas De Prost1,2, Marcelo Amato4, Guillaume Carteaux1,2 and Armand Mekontso Dessap1,2
Abstract Rationale: Patients with coronavirus disease-19-related acute respiratory distress syndrome (C-ARDS) could have a specific physiological phenotype as compared with those affected by ARDS from other causes (NC-ARDS). Objectives: To describe the effect of positive end-expiratory pressure (PEEP) on respiratory mechanics in C-ARDS patients in supine and prone position, and as compared to NC-ARDS. The primary endpoint was the best PEEP defined as the smallest sum of hyperdistension and collapse. Methods: Seventeen patients with moderate-to-severe C-ARDS were monitored by electrical impedance tomog‑ raphy (EIT) and evaluated during PEEP titration in supine (n = 17) and prone (n = 14) position and compared with 13 NC-ARDS patients investigated by EIT in our department before the COVID-19 pandemic. Results: As compared with NC-ARDS, C-ARDS exhibited a higher median best PEEP (defined using EIT as the smallest sum of hyperdistension and collapse, 12 [9, 12] vs. 9 [6, 9] cmH2O, p median) were compared with those with lower values. Owing to the exploratory nature of the study, no sample size calculation was needed. Ethical issues
This is an ancillary report of an ongoing prospective monocentric observational study on EIT in patients with ARDS (CPP-66/17). Written informed consent was waived due to the observational nature of the study.
Results Patient characteristics and outcomes
A total of 135 ARDS patients were admitted during the study period. Among them, 105 could not be included because of a contraindication to impedance tomography [including pacemaker or implantable defibrillator (n = 4),
skin lesion (n = 4)], or lack of availability of material or personnel (n = 97). Thus, the present study comprises 30 patients investigated by EIT with PEEP titration, including 17 with C-ARDS and 13 with NC-ARDS [bacterial pneumonia (n = 5), tuberculosis (n = 1), pneumocystis (n = 1), aspiration pneumonia (n = 3), interstitial lung disease (n = 1), and extra-pulmonary sepsis (n = 2)]. Patients were explored a median of 1 [1, 2] days after intubation. The characteristics and outcomes of included patients are summarized in Table 1. C-ARDS and NC-ARDS patients had similar characteristics and outcomes, except for significantly lower SAPS 2 at admission, and more cor pulmonale on echocardiography in the former group. Respiratory mechanics and PEEP titration
C-ARDS and NC-ARDS patients were similar in terms of hypoxemia, but with a trend to have higher body weights and respiratory system compliance in the former group (Tables 1, 2). The best PEEP (defined using EIT as the smallest sum of hyperdistension and collapse) ranged from 6 to 18 cmH2O, with
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