{"id":22449,"date":"2022-12-25T04:50:00","date_gmt":"2022-12-24T20:50:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22449"},"modified":"2022-12-25T06:07:08","modified_gmt":"2022-12-24T22:07:08","slug":"icu-management-practice-capnodynamic%e7%9b%91%e6%b5%8b%e8%af%84%e4%bc%b0%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e%e6%82%a3%e8%80%85%e7%9a%84peep","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22449","title":{"rendered":"[ICU Management &#038; Practice]: Capnodynamic\u76d1\u6d4b\u8bc4\u4f30\u65b0\u51a0\u80ba\u708e\u60a3\u8005\u7684PEEP"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Capnodynamic Monitoring to Assess PEEP in COVID-19<\/h1>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/res.cloudinary.com\/healthmanagement-org\/image\/upload\/f_auto,fl_lossy\/v1659434407\/cw\/00121853_cw_image.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p>Optimal positive end-expiratory pressure (PEEP) level during mechanical ventilation for COVID-19 pneumonia remains debated. A third of experts in a recent consensus statement supported a low-level PEEP for COVID-19-related acute respiratory failure (C-ARDS), with half of the panel remaining neutral without agreement on PEEP titration. However, the Surviving Sepsis Campaign guideline recommends using high level of PEEP for C-ARDS.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Ideally speaking, PEEP level should be guided by responses in lung volume and perfusion. Capnodynamic monitoring allows end-expiratory lung volume and effective pulmonary blood flow to be determined with ongoing ventilation.&nbsp;<\/p>\n\n\n\n<p>A recent study assessed the feasibility of capnodynamic monitoring of the responses to increased PEEP on gas exchange in mechanically ventilated patients with moderate to severe C-ARDS.<\/p>\n\n\n\n<p>Twenty-seven patients underwent capnodynamic monitoring of end-expiratory lung volume and effective pulmonary blood flow with a step increase in PEEP by 50% above the baseline. The primary outcome of the study was a &gt; 20 mm Hg increase in arterial oxygen tension to inspired fraction of oxygen (<em>P<\/em>\/<em>F<\/em>) ratio to differentiate between responders and non-responders. Secondary outcomes included changes in physiological dead space and correlations with independently determined recruited lung volume and the recruitment-to-inflation ratio at an instantaneous, single breath decrease in PEEP.&nbsp;<\/p>\n\n\n\n<p>The results of the study show that the PaO2\/FiO2 ratio increased &gt; 20 mm Hg from PEEPlow to PEEPhigh in 15 patients (responders). The same was not observed for the 12 other patients (non-responders). There was no significant difference between PaO2\/FiO2 among the responders and non-responders at PEEPlow for gas exchange and pulmonary mechanics. The PEEPhigh manoeuvre increased PaO2 in responders with an increase in PaO2\/FiO2 ratio.&nbsp;<\/p>\n\n\n\n<p>These findings show that in mechanically ventilated patients with moderate to severe C-ARDS, improved oxygenation in response to increased PEEP was associated with increased end-expiratory lung volume and pulmonary perfusion. Therefore, capnodynamic monitoring can be effectively used to assess physiological responses to PEEP at the bedside to facilitate individualised settings.&nbsp;<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-022-04110-0\" target=\"_blank\" rel=\"noreferrer noopener\">Critical Care&nbsp;<\/a><\/p>\n\n\n\n<p>Image Credit: iStock&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/healthmanagement.org\/c\/icu\/news\/prehospital-lyophilised-plasma-transfusion-for-trauma-induced-coagulopathy\">\u00ab\u00ab&nbsp;Prehospital Lyophilised Plasma Transfusion for Trauma-Induced Coagulopathy<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/healthmanagement.org\/c\/icu\/news\/clinical-outcomes-with-and-without-direct-discharge-home\">Clinical Outcomes With and Without Direct Discharge Home \u00bb\u00bb<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>Schulz L, Stewart A, O\u2019Regan W et al<em>.<\/em>&nbsp;(2022)&nbsp;<a href=\"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-022-04110-0\" target=\"_blank\" rel=\"noreferrer noopener\">Capnodynamic monitoring of lung volume and blood flow in response to increased positive end-expiratory pressure in moderate to severe COVID-19 pneumonia: an observational study.<\/a>&nbsp;Crit Care. 26<strong>,&nbsp;<\/strong>232<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Capnodynamic Monitoring to Assess PEEP in COVID-19 Opti [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22449"}],"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=22449"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22449\/revisions"}],"predecessor-version":[{"id":22450,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22449\/revisions\/22450"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}