Heart & lung : the journal of critical care · 2025
Short-term effects of positive end-expiratory pressure titration strategies on lung clinical markers in COVID-19: A randomized controlled trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Leite Wagner Souza, Campos Shirley Lima, Morais Caio César Araújo, Aquino Romulo, da Silva Júnior Emanuel Fernandes Ferreira, da Costa Feitosa Saulo Jose, De Melo Marianna De Fátima Araújo, Caetano Débora Sidrônio, Silva Thayse Neves Santos, Amato Marcelo Brito Passos, Brandão Daniella Cunha, de Andrade Armele Dornelas
Аннотация
BACKGROUND: Severe acute respiratory failure from COVID-19 is associated with high mortality. Optimal positive end-expiratory pressure (PEEP) titration is essential for lung-protective ventilation; however, different strategies may elicit distinct clinical responses.
OBJECTIVE: To compare the short-term effects of three PEEP titration strategies on lung injury score (LIS), changes in oxygenation, respiratory mechanics, and electrical impedance tomography (EIT) measures in mechanically ventilated patients with COVID-19.
METHODS: In this randomized, parallel-group trial, 75 intubated patients were randomly assigned to EIT-guided PEEP (PEEP-EIT), driving pressure-guided PEEP (PEEP-DP), or ARDSNet-based PEEP (PEEP-ARDSNet). Primary outcome was change in lung injury score (LIS); secondary outcomes included PaO₂/FiO₂ ≥ 150 mmHg, PaO₂/FiO₂ response ≥ 20 mmHg, driving pressure reduction, compliance increase, EIT-based regional ventilation and aeration, and adverse events within a four-hour follow-up.
RESULTS: Mean PEEP levels differed across groups: PEEP-EIT (13.3 cmH₂O), PEEP-DP (10.6 cmH₂O), and ARDSNet (12 cmH₂O). PEEP-EIT showed greater LIS reduction (ORweighted 3.7, 1.58 - 8.57; p = 0.004) and higher odds of oxygenation response vs. PEEP-DP (ORweighted 4.2, 2.15 - 8.27; p < 0.01) and PEEP-ARDSNet (ORweighted 3.6, 1.8- 7.1; p < 0.001). Both PEEP-EIT and PEEP-DP significantly improved driving pressure (PEEP-EIT: ORweighted 6.6, 2.6- 17.07; PEEP-DP: ORweighted 7.02, 2.7 - 18.2) and compliance (PEEP-EIT: ORweighted 9.5, 3.7- 24.33; PEEP-DP: ORweighted 5.94, 2.28 - 15.5) compared to PEEP-ARDSNet (p < 0.001 for both comparisons). No adverse events related to PEEP titration were reported.
CONCLUSION: EIT-guided PEEP titration outperformed ARDSNet and DP-guided strategies in reducing lung injury and improving compliance and oxygenation in patients with COVID-19.
OBJECTIVE: To compare the short-term effects of three PEEP titration strategies on lung injury score (LIS), changes in oxygenation, respiratory mechanics, and electrical impedance tomography (EIT) measures in mechanically ventilated patients with COVID-19.
METHODS: In this randomized, parallel-group trial, 75 intubated patients were randomly assigned to EIT-guided PEEP (PEEP-EIT), driving pressure-guided PEEP (PEEP-DP), or ARDSNet-based PEEP (PEEP-ARDSNet). Primary outcome was change in lung injury score (LIS); secondary outcomes included PaO₂/FiO₂ ≥ 150 mmHg, PaO₂/FiO₂ response ≥ 20 mmHg, driving pressure reduction, compliance increase, EIT-based regional ventilation and aeration, and adverse events within a four-hour follow-up.
RESULTS: Mean PEEP levels differed across groups: PEEP-EIT (13.3 cmH₂O), PEEP-DP (10.6 cmH₂O), and ARDSNet (12 cmH₂O). PEEP-EIT showed greater LIS reduction (ORweighted 3.7, 1.58 - 8.57; p = 0.004) and higher odds of oxygenation response vs. PEEP-DP (ORweighted 4.2, 2.15 - 8.27; p < 0.01) and PEEP-ARDSNet (ORweighted 3.6, 1.8- 7.1; p < 0.001). Both PEEP-EIT and PEEP-DP significantly improved driving pressure (PEEP-EIT: ORweighted 6.6, 2.6- 17.07; PEEP-DP: ORweighted 7.02, 2.7 - 18.2) and compliance (PEEP-EIT: ORweighted 9.5, 3.7- 24.33; PEEP-DP: ORweighted 5.94, 2.28 - 15.5) compared to PEEP-ARDSNet (p < 0.001 for both comparisons). No adverse events related to PEEP titration were reported.
CONCLUSION: EIT-guided PEEP titration outperformed ARDSNet and DP-guided strategies in reducing lung injury and improving compliance and oxygenation in patients with COVID-19.