Bedside personalized methods based on electrical impedance tomography or respiratory mechanics to set PEEP in ARDS and recruitment-to-inflation ratio: a physiologic study.
Acute lung injury
Collapsus
Esophageal pressure
Overdistension
PEEP titration
Recruitability
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
05 Jan 2024
05 Jan 2024
Historique:
received:
15
09
2023
accepted:
10
12
2023
medline:
5
1
2024
pubmed:
5
1
2024
entrez:
5
1
2024
Statut:
epublish
Résumé
Various Positive End-Expiratory Pressure (PEEP) titration strategies have been proposed to optimize ventilation in patients with acute respiratory distress syndrome (ARDS). We aimed to compare PEEP titration strategies based on electrical impedance tomography (EIT) to methods derived from respiratory system mechanics with or without esophageal pressure measurements, in terms of PEEP levels and association with recruitability. Nineteen patients with ARDS were enrolled. Recruitability was assessed by the estimated Recruitment-to-Inflation ratio (R/I Express and CoV strategies led to higher PEEP levels than the Positive P CoV and Express strategies led to higher PEEP levels than the Crossing Point and Positive P
Sections du résumé
BACKGROUND
BACKGROUND
Various Positive End-Expiratory Pressure (PEEP) titration strategies have been proposed to optimize ventilation in patients with acute respiratory distress syndrome (ARDS). We aimed to compare PEEP titration strategies based on electrical impedance tomography (EIT) to methods derived from respiratory system mechanics with or without esophageal pressure measurements, in terms of PEEP levels and association with recruitability.
METHODS
METHODS
Nineteen patients with ARDS were enrolled. Recruitability was assessed by the estimated Recruitment-to-Inflation ratio (R/I
RESULTS
RESULTS
Express and CoV strategies led to higher PEEP levels than the Positive P
CONCLUSIONS
CONCLUSIONS
CoV and Express strategies led to higher PEEP levels than the Crossing Point and Positive P
Identifiants
pubmed: 38180544
doi: 10.1186/s13613-023-01228-4
pii: 10.1186/s13613-023-01228-4
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1Informations de copyright
© 2023. The Author(s).
Références
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A, LUNG SAFE Investigators; ESICM Trials Group. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800.
doi: 10.1001/jama.2016.0291
pubmed: 26903337
Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A, Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8.
doi: 10.1056/NEJM200005043421801
pubmed: 10793162
Gattinoni L, Pelosi P, Crotti S, Valenza F. Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1995;151(6):1807–14.
doi: 10.1164/ajrccm.151.6.7767524
pubmed: 7767524
Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775–86.
doi: 10.1056/NEJMoa052052
pubmed: 16641394
Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I, Sklar MC, Rauseo M, Ferguson ND, Fan E, Richard JM, Brochard L. Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome. A clinical trial. Am J Respir Crit Care Med. 2020;201(2):178–87.
doi: 10.1164/rccm.201902-0334OC
pubmed: 31577153
Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L, Expiratory Pressure (Express) Study Group. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):646–55.
doi: 10.1001/jama.299.6.646
pubmed: 18270353
Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, Guimarães HP, Romano ER, Regenga MM, Taniguchi LNT, Teixeira C, Pinheiro de Oliveira R, Machado FR, Diaz-Quijano FA, Filho MSA, Maia IS, Caser EB, Filho WO, Borges MC, Martins PA, Matsui M, Ospina-Tascón GA, Giancursi TS, Giraldo-Ramirez ND, Vieira SRR, Assef MDGPL, Hasan MS, Szczeklik W, Rios F, Amato MBP, Berwanger O, Ribeiro de Carvalho CR. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318(14):1335–1345.
Beitler JR, Sarge T, Banner-Goodspeed VM, Gong MN, Cook D, Novack V, Loring SH, Talmor D, EPVent-2 Study Group. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-Fio2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2019;321(9):846–57.
doi: 10.1001/jama.2019.0555
pubmed: 30776290
pmcid: 6439595
Frerichs I, Amato MB, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, Bodenstein M, Gagnon H, Böhm SH, Teschner E, Stenqvist O, Mauri T, Torsani V, Camporota L, Schibler A, Wolf GK, Gommers D, Leonhardt S, Adler A, TREND study group. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2017;72(1):83–93.
doi: 10.1136/thoraxjnl-2016-208357
pubmed: 27596161
Victorino JA, Borges JB, Okamoto VN, Matos GF, Tucci MR, Caramez MP, Tanaka H, Sipmann FS, Santos DC, Barbas CS, Carvalho CR, Amato MB. Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med. 2004;169(7):791–800.
doi: 10.1164/rccm.200301-133OC
pubmed: 14693669
Scaramuzzo G, Spinelli E, Spadaro S, Santini A, Tortolani D, Dalla Corte F, Pesenti A, Volta CA, Grasselli G, Mauri T. Gravitational distribution of regional opening and closing pressures, hysteresis and atelectrauma in ARDS evaluated by electrical impedance tomography. Crit Care. 2020;24(1):622.
doi: 10.1186/s13054-020-03335-1
pubmed: 33092607
pmcid: 7579854
Yoshida T, Piraino T, Lima CAS, Kavanagh BP, Amato MBP, Brochard L. Regional ventilation displayed by electrical impedance tomography as an incentive to decrease PEEP. Am J Respir Crit Care Med. 2019;200(7):933–7.
doi: 10.1164/rccm.201904-0797LE
pubmed: 31225973
Costa ELV, Borges JB, Melo A, Suarez-Sipmann F, Toufen C, Bohm SH, Amato MBP. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009;35:1132–7.
doi: 10.1007/s00134-009-1447-y
pubmed: 19255741
Beloncle FM, Pavlovsky B, Desprez C, Fage N, Olivier PY, Asfar P, Richard JC, Mercat A. Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome. Ann Intensive Care. 2020;10(1):55.
doi: 10.1186/s13613-020-00675-7
pubmed: 32399901
pmcid: 7215140
Chen L, Del Sorbo L, Grieco DL, Shklar O, Junhasavasdikul D, Telias I, Fan E, Brochard L. Airway closure in acute respiratory distress syndrome: an underestimated and misinterpreted phenomenon. Am J Respir Crit Care Med. 2018;197(1):132–6.
doi: 10.1164/rccm.201702-0388LE
pubmed: 28557528
Sarge T, Baedorf-Kassis E, Banner-Goodspeed V, Novack V, Loring SH, Gong MN, Cook D, Talmor D, Beitler JR, EPVent-2 Study Group. Effect of Esophageal Pressure-guided Positive End-Expiratory Pressure on Survival from Acute Respiratory Distress Syndrome: A Risk-based and Mechanistic Reanalysis of the EPVent-2 Trial. Am J Respir Crit Care Med. 2021;204(10):1153–63.
doi: 10.1164/rccm.202009-3539OC
pubmed: 34464237
pmcid: 8759303
Fumagalli J, Santiago RRS, TeggiaDroghi M, Zhang C, Fintelmann FJ, Troschel FM, Morais CCA, Amato MBP, Kacmarek RM, Berra L, Lung Rescue Team Investigators. Lung Recruitment in Obese Patients with Acute Respiratory Distress Syndrome. Anesthesiology. 2019;130(5):791–803.
doi: 10.1097/ALN.0000000000002638
pubmed: 30844949
Jonkman AH, Alcala GC, Pavlovsky B, Roca O, Spadaro S, Scaramuzzo G, Chen L, Dianti J, Sousa MLA, Sklar MC, Piraino T, Ge H, Chen GQ, Zhou JX, Li J, Goligher EC, Costa E, Mancebo J, Mauri T, Amato M, Brochard LJ, Pleural PleasureWorking Group (PLUG). Lung recruitment assessed by electrical impedance tomography (RECRUIT): a multicenter study of COVID-19 ARDS. Am J Respir Crit Care Med. 2023;208(1):25–38.
doi: 10.1164/rccm.202212-2300OC
pubmed: 37097986
Mauri T, Spinelli E, Scotti E, Colussi G, Basile MC, Crotti S, Tubiolo D, Tagliabue P, Zanella A, Grasselli G, Pesenti A. Potential for lung recruitment and ventilation-perfusion mismatch in patients with the acute respiratory distress syndrome from coronavirus disease 2019. Crit Care Med. 2020;48(8):1129–34.
doi: 10.1097/CCM.0000000000004386
pubmed: 32697482
pmcid: 7188034
Dellamonica J, Lerolle N, Sargentini C, Beduneau G, Di Marco F, Mercat A, Richard JC, Diehl JL, Mancebo J, Rouby JJ, Lu Q, Bernardin G, Brochard L. PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment. Intensive Care Med. 2011;37(10):1595–604.
doi: 10.1007/s00134-011-2333-y
pubmed: 21866369
Chiumello D, Cressoni M, Carlesso E, Caspani ML, Marino A, Gallazzi E, Caironi P, Lazzerini M, Moerer O, Quintel M, Gattinoni L. Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome. Crit Care Med. 2014;42(2):252–64.
doi: 10.1097/CCM.0b013e3182a6384f
pubmed: 24196193
Perier F, Tuffet S, Maraffi T, Alcala G, Victor M, Haudebourg AF, Razazi K, De Prost N, Amato M, Carteaux G, Mekontso DA. Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome. Crit Care. 2020;24(1):678.
doi: 10.1186/s13054-020-03414-3
pubmed: 33287864
pmcid: 7719729
Su PL, Lin WC, Ko YF, Su PF, Chen CW. Positive end-expiratory pressure selection based on best respiratory system compliance or collapse/hyperdistension curves in patients with acute respiratory distress syndrome: lack of correlation with alveolar recruitment. Intensive Care Med. 2018;44(3):389–91.
doi: 10.1007/s00134-017-5022-7
pubmed: 29238846
Zhao Z, Chang MY, Chang MY, Gow CH, Zhang JH, Hsu YL, Frerichs I, Chang HT, Möller K. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve in severe acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):7.
doi: 10.1186/s13613-019-0484-0
pubmed: 30656479
pmcid: 6336593
Blankman P, Hasan D, Erik G, Gommers D. Detection of “best” positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care. 2014;18(3):R95.
doi: 10.1186/cc13866
pubmed: 24887391
pmcid: 4095609
Scaramuzzo G, Spadaro S, Dalla Corte F, Waldmann AD, Böhm SH, Ragazzi R, Marangoni E, Grasselli G, Pesenti A, Volta CA, Mauri T. Personalized positive end-expiratory pressure in acute respiratory distress syndrome: comparison between optimal distribution of regional ventilation and positive transpulmonary pressure. Crit Care Med. 2020;48(8):1148–56.
doi: 10.1097/CCM.0000000000004439
pubmed: 32697485
Gibot S, Conrad M, Courte G, Cravoisy A. Positive end-expiratory pressure setting in covid-19-related acute respiratory distress syndrome: comparison between electrical impedance tomography, PEEP/FiO
doi: 10.3389/fmed.2021.720920
pubmed: 35004712
Franchineau G, Bréchot N, Lebreton G, Hekimian G, Nieszkowska A, Trouillet JL, Leprince P, Chastre J, Luyt CE, Combes A, Schmidt M. Bedside contribution of electrical impedance tomography to setting positive end-expiratory pressure for extracorporeal membrane oxygenation–treated patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;196(4):447–57.
doi: 10.1164/rccm.201605-1055OC
pubmed: 28103448
van der Zee P, Somhorst P, Endeman H, Gommers D. Electrical impedance tomography for positive end-expiratory pressure titration in COVID-19-related acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020;202(2):280–4.
doi: 10.1164/rccm.202003-0816LE
pubmed: 32479112
pmcid: 7365366
Zhao Z, Lee LC, Chang MY, Frerichs I, Chang HT, Gow CH, Hsu YL, Möller K. The incidence and interpretation of large differences in EIT-based measures for PEEP titration in ARDS patients. J Clin Monit Comput. 2020;34(5):1005–13.
doi: 10.1007/s10877-019-00396-8
pubmed: 31587120
Beloncle F, Studer A, Seegers V, Richard JC, Desprez C, Fage N, Merdji H, Pavlovsky B, Helms J, Cunat S, Mortaza S, Demiselle J, Brochard L, Mercat A, Meziani F. Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 vs non-COVID-19 pulmonary acute respiratory distress syndrome. Crit Care. 2021;25(1):248.
doi: 10.1186/s13054-021-03665-8
pubmed: 34266454
pmcid: 8280689
Panwar R, Madotto F, Laffey JG, van Haren FMP. Compliance phenotypes in early acute respiratory distress syndrome before the COVID-19 pandemic. Am J Respir Crit Care Med. 2020;202(9):1244–52.
doi: 10.1164/rccm.202005-2046OC
pubmed: 32805143
pmcid: 7605177
Mauri T, Eronia N, Turrini C, Battistini M, Grasselli G, Rona R, Volta CA, Bellani G, Pesenti A. Bedside assessment of the effects of positive end-expiratory pressure on lung inflation and recruitment by the helium dilution technique and electrical impedance tomography. Intensive Care Med. 2016;42(10):1576–87.
doi: 10.1007/s00134-016-4467-4
pubmed: 27518321