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 <0.001; CI 99%) that continued daily up to 72 h ( p <0.001; CI 99%). Median ICU LOS was 15 days (10–28); median duration of IMV was 12 days (8–26). The ICU mortality rate was 31.6%. Lower PEEP strategy treatment in L-type COVID-19 ARDS resulted in a PaO 2 /FiO 2 ratio persistent daily improvement during the first 72 h of IMV. A lower PEEP strategy could be beneficial in the first phase of ARDS in critically ill COVID-19 patients.
【저자키워드】 COVID-19, mechanical ventilation, adult respiratory distress syndrome, PaO2/FiO2, Positive-end-expiratory respiration, 【초록키워드】 Treatment, Evolution, ARDS, ICU, Critically ill, Patient, Retrospective analysis, Clinical management, mortality rate, BMI, COVID-19 patients, COVID-19 patient, Safe, PEEP, lung damage, Standard of care, LOS, Endpoint, secondary endpoint, standard treatment, syndrome, Severe respiratory distress, Lower, L-type, IMV, evaluate, conducted, applied, median, treated, occur, consecutive patient, PaO, with COVID-19, 【제목키워드】 PEEP, Ratio, Mechanical, PaO,