Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Critical Care Year : 2020

Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome

François Perier
Samuel Tuffet
  • Function : Author
Tommaso Maraffi
  • Function : Author
Glasiele Alcala
  • Function : Author
Marcus Victor
  • Function : Author
Anne-Fleur Haudebourg
  • Function : Author
Keyvan Razazi
  • Function : Author
Nicolas de Prost
Marcelo Amato
  • Function : Author
Guillaume Carteaux
  • Function : Author

Abstract

Abstract Rationale Patients with coronavirus disease-19-related acute respiratory distress syndrome (C-ARDS) could have a specific physiological phenotype as compared with those affected by ARDS from other causes (NC-ARDS). Objectives To describe the effect of positive end-expiratory pressure (PEEP) on respiratory mechanics in C-ARDS patients in supine and prone position, and as compared to NC-ARDS. The primary endpoint was the best PEEP defined as the smallest sum of hyperdistension and collapse. Methods Seventeen patients with moderate-to-severe C-ARDS were monitored by electrical impedance tomography (EIT) and evaluated during PEEP titration in supine ( n = 17) and prone ( n = 14) position and compared with 13 NC-ARDS patients investigated by EIT in our department before the COVID-19 pandemic. Results As compared with NC-ARDS, C-ARDS exhibited a higher median best PEEP (defined using EIT as the smallest sum of hyperdistension and collapse, 12 [9, 12] vs. 9 [6, 9] cmH 2 O, p < 0.01), more collapse at low PEEP, and less hyperdistension at high PEEP. The median value of the best PEEP was similar in C-ARDS in supine and prone position: 12 [9, 12] vs. 12 [10, 15] cmH 2 O, p = 0.59. The response to PEEP was also similar in C-ARDS patients with higher vs. lower respiratory system compliance. Conclusion An intermediate PEEP level seems appropriate in half of our C-ARDS patients. There is no solid evidence that compliance at low PEEP could predict the response to PEEP.

Dates and versions

hal-04395566 , version 1 (15-01-2024)

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Cite

François Perier, Samuel Tuffet, Tommaso Maraffi, Glasiele Alcala, Marcus Victor, et al.. Electrical impedance tomography to titrate positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome. Critical Care, 2020, 24 (1), pp.678. ⟨10.1186/s13054-020-03414-3⟩. ⟨hal-04395566⟩

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