TY - JOUR
T1 - Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia
AU - on behalf of GECOVID (GEnoa COVID-19) group
AU - Ball, Lorenzo
AU - Robba, Chiara
AU - Maiello, Lorenzo
AU - Herrmann, Jacob
AU - Gerard, Sarah E.
AU - Xin, Yi
AU - Battaglini, Denise
AU - Brunetti, Iole
AU - Minetti, Giuseppe
AU - Seitun, Sara
AU - Vena, Antonio
AU - Giacobbe, Daniele Roberto
AU - Bassetti, Matteo
AU - Rocco, Patricia R.M.
AU - Cereda, Maurizio
AU - Castellan, Lucio
AU - Patroniti, Nicolò
AU - Pelosi, Paolo
AU - Ball, Lorenzo
AU - Gratarola, Angelo
AU - Loconte, Maurizio
AU - Molin, Alexandre
AU - Orefice, Giulia
AU - Iannuzzi, Francesca
AU - Costantino, Federico
AU - Battioni, Dario
AU - Bovio, Giulio
AU - Buconte, Gerolama
AU - Casaleggio, Alessandro
AU - Cittadini, Giuseppe
AU - Dogliotti, Luca
AU - Giasotto, Veronica
AU - Pigati, Maria
AU - Santacroce, Elena
AU - Zaottini, Federico
AU - Dentone, Chiara
AU - Taramasso, Lucia
AU - Magnasco, Laura
AU - Valbusa, Alberto
AU - Bastianello, Matilde
N1 - Funding Information:
We are grateful for the efforts of the GECOVID (GEnoa COVID-19) group: Angelo Gratarola, Maurizio Loconte, Alexandre Molin, Giulia Orefice, Francesca Iannuzzi, Federico Costantino, Dario Battioni, Giulio Bovio, Gerolama Buconte, Alessandro Casaleggio, Giuseppe Cittadini, Luca Dogliotti, Veronica Giasotto, Maria Pigati, Elena Santacroce, Federico Zaottini, Chiara Dentone, Lucia Taramasso, Laura Magnasco, Alberto Valbusa, Matilde Bastianello.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Background: There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. Methods: A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH2O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Results: Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7–4.5] % of lung weight and was not associated with excess lung weight, PaO2/FiO2 ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD − 9 ml/cmH2O, 95% CI from − 12 to − 6 ml/cmH2O, p < 0.001) and the ventilatory ratio (MD − 0.1, 95% CI from − 0.3 to − 0.1, p = 0.003), increased PaO2 with FiO2 = 0.5 (MD 24 mmHg, 95% CI from 12 to 51 mmHg, p < 0.001), but did not change PaO2 with FiO2 = 1.0 (MD 7 mmHg, 95% CI from − 12 to 49 mmHg, p = 0.313). Moreover, alveolar recruitment was not correlated with improvement of oxygenation or venous admixture. Conclusions: In patients with severe COVID-19 pneumonia, higher PEEP resulted in limited alveolar recruitment. These findings suggest limiting PEEP strictly to the values necessary to maintain oxygenation, thus avoiding the use of higher PEEP levels.
AB - Background: There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. Methods: A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH2O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Results: Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7–4.5] % of lung weight and was not associated with excess lung weight, PaO2/FiO2 ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD − 9 ml/cmH2O, 95% CI from − 12 to − 6 ml/cmH2O, p < 0.001) and the ventilatory ratio (MD − 0.1, 95% CI from − 0.3 to − 0.1, p = 0.003), increased PaO2 with FiO2 = 0.5 (MD 24 mmHg, 95% CI from 12 to 51 mmHg, p < 0.001), but did not change PaO2 with FiO2 = 1.0 (MD 7 mmHg, 95% CI from − 12 to 49 mmHg, p = 0.313). Moreover, alveolar recruitment was not correlated with improvement of oxygenation or venous admixture. Conclusions: In patients with severe COVID-19 pneumonia, higher PEEP resulted in limited alveolar recruitment. These findings suggest limiting PEEP strictly to the values necessary to maintain oxygenation, thus avoiding the use of higher PEEP levels.
KW - ARDS
KW - COVID-19
KW - CT scan
KW - Mechanical ventilation
KW - Respiratory system mechanics
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U2 - 10.1186/s13054-021-03477-w
DO - 10.1186/s13054-021-03477-w
M3 - Article
C2 - 33627160
AN - SCOPUS:85101741943
VL - 25
JO - Critical Care
JF - Critical Care
SN - 1466-609X
IS - 1
M1 - 81
ER -