Journal Club - Lung Response to a Higher Positive End-Expiratory Pressure in Mechanically Ventilated Patients With COVID-19
By: Marcelo Alcantara, Médico - 04/12/2022 16:34
In this interesting paper, Protti et al. describe the lung response to different levels of PEEP and pressurization of the airways in patients with severe COVID-19 and ARDS.
They studied forty patients with chest CT, measurements of lung aeration, recruitment, and hyperinflation with airway pressures of 5cmH2O and 45cmh2O and tested the physiological response to 5, 10, and 15cmH2O of PEEP.
Both lung recruitment and overinflation occurred, but the latter was predominant with higher PEEP levels.
In the authors' opinion, neither lung compliance nor driving pressure showed value in reflecting the degree of recruitment or overinflation.
I disagree a little as the online data supplement PEEP of 10cmh2O resulted in better results of compliance, driving pressure, and more recruitment than hyperinflation.
PaCO2 did not show significant variations, and P/F constantly improved with higher PEEP.
In particular, I found the results very much as expected, and it did not change my practice at the bedside.
I agree with the accompanying editorial, we must individualize PEEP settings at all times, and maybe values around 10cmH2O are probably safer than higher values.
Please check the paper in the link below.
Protti, Alessandro et al. "Lung Response to a Higher Positive End-Expiratory Pressure in Mechanically Ventilated Patients With COVID-19." Chest vol. 161,4 (2022): 979-988. doi:10.1016/j.chest.2021.10.012
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