Low PEEP Mechanical Ventilation and PaO2/FiO2 Ratio Evolution in COVID-19 Patients

• Published in: SN comprehensive clinical medicine 2021, Vol.3 (12), p.2435-2442
• Main Authors: Ceruti, Samuele, Roncador, Marco, Saporito, Andrea, Biggiogero, Maira, Glotta, Andrea, Maida, Pier Andrea, Urso, Patrizia, Bona, Giovanni, Garzoni, Christian, Mauri, Romano, Borgeat, Alain
• Format: Article
• Language: English
• Subjects: Covid-19; Medicine; Medicine & Public Health; Topical Collection on COVID-19
• ISSN: 2523-8973; 2523-8973
• DOI: 10.1007/s42399-021-01031-x

Invasive mechanical ventilation (IMV) is the standard treatment in critically ill COVID-19 patients with acute severe respiratory distress syndrome (ARDS). When IMV setting is extremely aggressive, especially through the application of high positive-end-expiratory respiration (PEEP) values, lung damage can occur. Until today, in COVID-19 patients, two types of ARDS were identified (L- and H-type); for the L-type, a lower PEEP strategy was supposed to be preferred, but data are still missing. The aim of this study was to evaluate if a clinical management with lower PEEP values in critically ill L-type COVID-19 patients was safe and efficient in comparison to usual standard of care. A retrospective analysis was conducted on consecutive patients with COVID-19 ARDS admitted to the ICU and treated with IMV. Patients were treated with a lower PEEP strategy adapted to BMI: PEEP 10 cmH 2 O if BMI < 30 kg m −2 , PEEP 12 cmH 2 O if BMI 30–50 kg m −2 , PEEP 15 cmH 2 O if BMI > 50 kg m −2 . Primary endpoint was the PaO 2 /FiO 2 ratio evolution during the first 3 IMV days; secondary endpoints were to analyze ICU length of stay (LOS) and IMV length. From March 2 to January 15, 2021, 79 patients underwent IMV. Average applied PEEP was 11 ± 2.9 cmH 2 O for BMI < 30 kg m −2 and 16 ± 3.18 cmH 2 O for BMI > 30 kg m −2 . During the first 24 h of IMV, patients’ PaO 2 /FiO 2 ratio presented an improvement ( p