Response to PEEP in COVID-19 ARDS patients with and without extracorporeal membrane oxygenation. A multicenter case-control computed tomography study.
ARDS
COVID-19
Computed tomography
ECMO
PEEP
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
02 07 2022
02 07 2022
Historique:
received:
28
04
2022
accepted:
27
06
2022
entrez:
2
7
2022
pubmed:
3
7
2022
medline:
8
7
2022
Statut:
epublish
Résumé
PEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT). We conducted a two-center prospective observational case-control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72 h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS. Non-inflated lung at PEEP 5 cmH Lung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH
Sections du résumé
BACKGROUND
PEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT).
METHODS
We conducted a two-center prospective observational case-control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72 h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS.
RESULTS
Non-inflated lung at PEEP 5 cmH
CONCLUSIONS
Lung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH
Identifiants
pubmed: 35780154
doi: 10.1186/s13054-022-04076-z
pii: 10.1186/s13054-022-04076-z
pmc: PMC9250720
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
195Informations de copyright
© 2022. The Author(s).
Références
Crit Care Med. 2019 Sep;47(9):1177-1183
pubmed: 31419216
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Intensive Care Med. 2020 Dec;46(12):2187-2196
pubmed: 33089348
N Engl J Med. 2006 Apr 27;354(17):1775-86
pubmed: 16641394
Am J Respir Crit Care Med. 2014 Jan 15;189(2):149-58
pubmed: 24261322
J Crit Care. 2020 Dec;60:169-176
pubmed: 32854088
Am J Respir Crit Care Med. 2016 Jun 1;193(11):1254-63
pubmed: 26699672
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Am J Respir Crit Care Med. 2001 Nov 1;164(9):1701-11
pubmed: 11719313
Anesthesiology. 1988 Dec;69(6):824-32
pubmed: 3057937
Front Med (Lausanne). 2021 Jan 22;7:603943
pubmed: 33553203
Am J Respir Crit Care Med. 2020 May 15;201(10):1294-1297
pubmed: 32200645
Chest. 2022 Apr;161(4):979-988
pubmed: 34666011
Am J Respir Crit Care Med. 2019 Mar 1;199(5):603-612
pubmed: 30216736
N Engl J Med. 2000 May 4;342(18):1301-8
pubmed: 10793162
Am J Respir Crit Care Med. 1994 Jan;149(1):8-13
pubmed: 8111603
Am Rev Respir Dis. 1987 Sep;136(3):730-6
pubmed: 3307572
Am J Respir Crit Care Med. 2007 Jan 15;175(2):160-6
pubmed: 17038660
Crit Care Med. 2020 May;48(5):623-633
pubmed: 32141923
Intensive Care Med. 2017 May;43(5):603-611
pubmed: 28283699
Lancet. 2020 Oct 10;396(10257):1071-1078
pubmed: 32987008
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Biom J. 2008 Jun;50(3):346-63
pubmed: 18481363
J Appl Physiol (1985). 2016 Dec 1;121(6):1335-1347
pubmed: 27445302
Crit Care. 2021 Feb 24;25(1):81
pubmed: 33627160
Am J Respir Crit Care Med. 2020 Jan 15;201(2):178-187
pubmed: 31577153
Lancet Respir Med. 2020 Nov;8(11):1121-1131
pubmed: 32798468
PLoS One. 2022 Jan 20;17(1):e0262179
pubmed: 35051205
Ann Intensive Care. 2020 May 12;10(1):55
pubmed: 32399901