{"id":21911,"date":"2022-07-26T04:59:00","date_gmt":"2022-07-25T20:59:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21911"},"modified":"2022-07-26T05:31:30","modified_gmt":"2022-07-25T21:31:30","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8e%a5%e5%8f%97%e6%9c%ba%e6%a2%b0%e9%80%9a%e6%b0%94%e7%9a%84%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e%e6%82%a3%e8%80%85%e8%82%ba%e9%83%a8%e5%af%b9","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21911","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684\u65b0\u51a0\u80ba\u708e\u60a3\u8005\u80ba\u90e8\u5bf9\u9ad8PEEP\u7684\u53cd\u5e94"},"content":{"rendered":"\n

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 161, ISSUE 4<\/a>, P979-988, APRIL 01, 2022<\/p>\n\n\n\n

Lung Response to a Higher Positive End-Expiratory Pressure in Mechanically Ventilated Patients With COVID-19<\/h1>\n\n\n\n

Alessandro Protti, Alessandro Santini, Francesca Pennati,\u00a0et al<\/h3>\n\n\n\n

Chest 2022; 161: 979-988<\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

International guidelines suggest using a higher (> 10 cm H2<\/sub>O) positive end-expiratory pressure (PEEP) in patients with moderate-to-severe ARDS due to COVID-19. However, even if oxygenation generally improves with a higher PEEP, compliance, and Paco2<\/sub> frequently do not, as if recruitment was small.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

Is the potential for lung recruitment small in patients with early ARDS due to COVID-19?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

Forty patients with ARDS due to COVID-19 were studied in the supine position within 3 days of endotracheal intubation. They all underwent a PEEP trial, in which oxygenation, compliance, and Paco2<\/sub> were measured with 5, 10, and 15 cm H2<\/sub>O of PEEP, and all other ventilatory settings unchanged. Twenty underwent a whole-lung static CT scan at 5 and 45 cm H2<\/sub>O, and the other 20 at 5 and 15 cm H2<\/sub>O of airway pressure. Recruitment and hyperinflation were defined as a decrease in the volume of the non-aerated (density above \u2212100 HU) and an increase in the volume of the over-aerated (density below \u2212900 HU) lung compartments, respectively.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

From 5 to 15 cm H2<\/sub>O, oxygenation improved in 36 (90%) patients but compliance only in 11 (28%) and Paco2<\/sub> only in 14 (35%). From 5 to 45 cm H2<\/sub>O, recruitment was 351 (161-462) mL and hyperinflation 465 (220-681) mL. From 5 to 15 cm H2<\/sub>O, recruitment was 168 (110-202) mL and hyperinflation 121 (63-270) mL. Hyperinflation variably developed in all patients and exceeded recruitment in more than half of them.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Patients with early ARDS due to COVID-19, ventilated in the supine position, present with a large potential for lung recruitment. Even so, their compliance and Paco2<\/sub> do not generally improve with a higher PEEP, possibly because of hyperinflation.<\/p>\n","protected":false},"excerpt":{"rendered":"

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 161, ISSU […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21911"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21911"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21911\/revisions"}],"predecessor-version":[{"id":21912,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21911\/revisions\/21912"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21911"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21911"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21911"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}