Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia.
Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia.
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DOI：
10.1186/s13054-021-03477-w
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发表时间：
2021-02-24
期刊：
影响因子：
--
通讯作者：
GECOVID (GEnoa COVID-19) group
中科院分区：
文献类型：
--
作者：
Ball L;Robba C;Maiello L;Herrmann J;Gerard SE;Xin Y;Battaglini D;Brunetti I;Minetti G;Seitun S;Vena A;Giacobbe DR;Bassetti M;Rocco PRM;Cereda M;Castellan L;Patroniti N;Pelosi P;GECOVID (GEnoa COVID-19) group
关于COVID-19肺炎患者的最佳呼吸机管理的数据很少;特别是，呼气末正压（PEEP）的最佳水平尚不清楚。我们旨在研究两种水平的PEEP对重症COVID-19肺炎患者肺泡复张的影响。在意大利热那亚的一所大学附属医院的39张床位的重症监护病房进行了一项单中心队列研究。进行胸部计算机断层扫描（CT）以量化8和16 cmH 2 O PEEP下的通气。主要终点是肺泡复张量，定义为CT扫描上两个PEEP水平下非通气室的变化。42例患者纳入本分析。肺泡复张的中位数[四分位距]为肺重量的2.7 [0.7-4.5] %，与肺重量过重、PaO 2/FiO 2比值、呼吸系统顺应性、炎症和血栓形成倾向标志物无关。与非招募者相比，招募的上四分位数患者（招募者）具有相似的临床特征、肺重量和气体体积。在呼吸系统顺应性较低和较高的患者中，肺泡复张没有差异。在一个有气体交换数据的20例患者的亚组中，增加PEEP降低了呼吸系统的顺应性（中位差异，MD − 9 ml/cmH 2 O，95% CI从− 12至− 6 ml/cmH 2 O，p < 0.001）（MD − 0.1，95% CI从− 0.3至− 0.1，p = 0.003），PaO 2增加，FiO 2 = 0.5（MD 24 mmHg，95% CI从12至51 mmHg，p < 0.001），但在FiO 2 = 1.0时未改变PaO 2（MD 7 mmHg，95% CI从− 12至49 mmHg，p = 0.313）。此外，肺泡复张与氧合或静脉混合的改善无关。在严重COVID-19肺炎患者中，较高的PEEP导致肺泡复张有限。这些结果表明，严格限制PEEP的值，以维持氧合，从而避免使用更高的PEEP水平。
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. 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. 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. 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.
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影响因子：
24.3
作者：
Pelosi, P;D'Onofrio, D;Gattinoni, L
通讯作者：
Gattinoni, L
DOI：
10.1016/s2213-2600(20)30370-2
发表时间：
2020-12
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Grasselli G;Tonetti T;Protti A;Langer T;Girardis M;Bellani G;Laffey J;Carrafiello G;Carsana L;Rizzuto C;Zanella A;Scaravilli V;Pizzilli G;Grieco DL;Di Meglio L;de Pascale G;Lanza E;Monteduro F;Zompatori M;Filippini C;Locatelli F;Cecconi M;Fumagalli R;Nava S;Vincent JL;Antonelli M;Slutsky AS;Pesenti A;Ranieri VM;collaborators
通讯作者：
collaborators
DOI：
10.1164/ajrccm.163.6.2005001
发表时间：
2001-05-01
影响因子：
24.7
作者：
Malbouisson, LM;Muller, JC;Rouby, JJ
通讯作者：
Rouby, JJ
影响因子：
10.9
作者：
Gerard, Sarah E.;Herrmann, Jacob;Reinhardt, Joseph M.
通讯作者：
Reinhardt, Joseph M.
影响因子：
8.1
作者：
Diehl, J-L;Peron, N.;Smadja, D. M.
通讯作者：
Smadja, D. M.