| Author | Cruz, Mônica Rodrigues da | |
| Author | Camilo, Luciana Moisés | |
| Author | Xavier, Tiago Batista da Costa | |
| Author | Ribeiro, Gabriel Casulari da Motta | |
| Author | Medeiros, Denise Machado | |
| Author | Reis, Luís Felipe da Fonseca | |
| Author | Guimarães, Bruno Leonardo da Silva | |
| Author | Japiassú, André Miguel | |
| Author | Carvalho, Alysson Roncally Silva | |
| Access date | 2023-06-13T00:46:57Z | |
| Available date | 2023-06-13T00:46:57Z | |
| Document date | 2023 | |
| Citation | CRUZ, Mônica Rodrigues da et al. Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients. Critical Care Forum, v. 27, n. 1, p. 1-6, Mar. 2023. | en_US |
| ISSN | 1364-8535 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/58993 | |
| Description | Ethics approval and consent to participate: Protocols were approved by institutional review boards of the National Institute of Infections Diseases (CAAE 31050420.8.2001.5262), Pedro Ernesto University Hospital (CAAE 31050420.8.1001.5259), Brazilian clinical trials (RBR-2z3f7k). | en_US |
| Sponsorship | This research was supported by Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brasil. Brazilian Council for Scientifc and Technological Development (Conselho Nacional de Desenvolvimento Científco e Tecnológico, Grants Nos. 302702/2017-2 and 302839/2017-8) and the Rio de Janeiro State Research Supporting Foundation (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro, Grants Nos. E26/211.867/2016, E-26/202.785/2017, E-26/203.001/2018). Institutional Incentive Program for Scientifc, Technological and Artistic-Cultural Production—PROCIÊNCIA 2019-2020, from the Federal Institute of Education, Science and Technology, Rio de Janeiro (IFRJ). | en_US |
| Language | eng | en_US |
| Publisher | BioMed Central Ltd. | en_US |
| Rights | open access | en_US |
| Title | Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients | en_US |
| Type | Article | en_US |
| DOI | 10.1186/s13054-021-03839-4 | |
| Abstract | Background: The profile of changes in airway driving pressure (dPaw) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dPaw versus PEEP curves behavior in ARDS from COVID-19 patients. Methods: Patients admitted in three hospitals were ventilated with fraction of inspired oxygen (FiO2) and PEEP initially adjusted by oxygenation-based table. Thereafter, PEEP was reduced from 20 until 6 cmH2O while dPaw was stepwise recorded and the lowest PEEP that minimized dPaw (PEEPmin_dPaw) was assessed. Each dPaw vs PEEP curve was classified as J-shaped, inverted-J-shaped, or U-shaped according to the difference between the minimum dPaw and the dPaw at the lowest and highest PEEP. In one hospital, hyperdistention and collapse at each PEEP were assessed by electrical impedance tomography (EIT). Results: 184 patients (41 including EIT) were studied. 126 patients (68%) exhibited a J-shaped dPaw vs PEEP profile (PEEPmin_dPaw of 7.5 ± 1.9 cmH2O). 40 patients (22%) presented a U (PEEPmin_dPaw of 12.2 ± 2.6 cmH2O) and 18 (10%) an inverted-J profile (PEEPmin_dPaw of 14,6 ± 2.3 cmH2O). Patients with inverted-J profiles had significant higher body mass index (BMI) and lower baseline partial pressure of arterial oxygen/FiO2 ratio. PEEPmin_dPaw was associated with lower fractions of both alveolar collapse and hyperinflation. Conclusions: A PEEP adjustment procedure based on PEEP-induced changes in dPaw is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Instituto de Educação, Ciência e Tecnologia do Rio de Janeiro. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Instituto de Educação, Ciência e Tecnologia do Rio de Janeiro. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro. Programa Doutor Empreendedo. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Hospital Central da Polícia Militar. Rio de Janeiro, RJ, Brasil / Centro Universitário Augusto Motta. Programa de Pós-Graduação em Ciências da Reabilitação. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Hospital Niterói D'Or. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Universidade Federal do Rio de Janeiro. Instituto de Biofísica Carlos Chagas Filho. Laboratório de Fisiologia da Respiração. Rio de Janeiro, RJ, Brasil / Instituto D'or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brasil / Hospital Barra D'Or. Rio de Janeiro, RJ, Brasil. | en_US |
| Subject | Acute Respiratory Distress Syndrome | en_US |
| Subject | COVID-19 | en_US |
| Subject | Electrical impedance tomography | en_US |
| Subject | Mechanical ventilation | en_US |
| Subject | Positive end-expiratory pressure | en_US |
| e-ISSN | 1466-609X | |
