Ruiz CÁ, Rodríguez ZC, Meza HÓMO, Aguirre SJS, Martínez DBA

Language: Spanish
References: 5
Page: 433-438
PDF size: 315.48 Kb.

ABSTRACT

Introduction: in patients with moderate-severe Acute Respiratory Distress Syndrome (ARDS) secondary to SARS-CoV-2 infection who were under mechanical ventilation, it is necessary to perform an adequate titration of PEEP within the management. Currently, various methods are available; we focused the study on two useful methods that can be carried out in any center. The use of the best compliance method was described above and is an effective approach to obtain an adequate PEEP that will maintain lung protection goals. It is proposed that the following simplified formula for pulmonary elastic recoil pressure serve as a new proposal within therapeutic measures. PEEPel = P. plateau − 13.5 ± 2. Objectives: to demonstrate that the calculation of PEEP using the pulmonary elastic recoil formula presents similar results to the best compliance metho d. Material and methods: a retrospective analysis was performed on patients who presented moderate-severe ARDS secondary to SARS-CoV-2 infection and who were under mechanical ventilation. As a process study where PEEP was obtained by better compliance, the calculation was compared with the initial plateau pressure with a statistical test, frequencies, percentages and interquartile range. For the comparison between both metho ds, the Wilcoxon test was used. Results: two hundred patients were included: undergoing mechanical ventilation; who underwent PEEP titration using both metho ds described, the correlation performed by the Wilcoxon test was 0.426 with statistical significance < 0.001, with lower confidence intervals of 0.296 and higher of 0.541. Demographic values: mean age 60 ± 12.7, male predominance 143 (77.7%), mean SOFA score 6 (2.8), APACHE II 12 (8.19), SAPS II 27.5 (22.43). Conclusions: the above results show a correlation between both metho ds for titrating the appropriate PEEP; however, the formula was used in this study with the plateau pressure established for better compliance with the metho d. A prospective study would be recommended in the same patient population, with a baseline plateau pressure to evaluate it as a new option for an easily accessible PEEP titration metho d in the future.

REFERENCES

1. Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet. 2021;398(10300):622-637.

2. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788-800.

3. Bellani G, Laffey JG, Pham T, Fan E; LUNG SAFE Investigators and the ESICM Trials Group. The LUNG SAFE study: a presentation of the prevalence of ARDS according to the Berlin Definition! Crit Care. 2016;20(1):268.

4. Lemos-Filho LB, Mikkelsen ME, Martin GS, Dabbagh O, Adesanya A, Gentile N, et al. Sex, race, and the development of acute lung injury. Chest. 2013;143(4):901-909.

5. Passos AMB, Valente-Barbas CS, Machado-Medeiros D, Borges-Magaldi R, Paula-Schettino G, Geraldo Lorenzi-Filho, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347-354.