Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia

Lorenzo Ball; Chiara Robba; Lorenzo Maiello; Jacob Herrmann; Sarah E Gerard; Yi Xin; Denise Battaglini; Iole Brunetti; Giuseppe Minetti; Sara Seitun; Antonio Vena; Daniele Roberto Giacobbe; Matteo Bassetti; Patricia R M Rocco; Maurizio Cereda; Lucio Castellan; Nicolò Patroniti; Paolo Pelosi; GECOVID (GEnoa COVID-19) group

doi:10.1186/s13054-021-03477-w

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Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia

Journal article

Open access

Peer reviewed

Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia

Lorenzo Ball, Chiara Robba, Lorenzo Maiello, Jacob Herrmann, Sarah E Gerard, Yi Xin, Denise Battaglini, Iole Brunetti, Giuseppe Minetti, Sara Seitun, …

Critical care (London, England), Vol.25(1), pp.81-81

02/24/2021

DOI: 10.1186/s13054-021-03477-w

PMCID: PMC7903929

PMID: 33627160

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Abstract

There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7-4.5] % of lung weight and was not associated with excess lung weight, PaO /FiO ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD - 9 ml/cmH O, 95% CI from - 12 to - 6 ml/cmH O, p < 0.001) and the ventilatory ratio (MD - 0.1, 95% CI from - 0.3 to - 0.1, p = 0.003), increased PaO with FiO = 0.5 (MD 24 mmHg, 95% CI from 12 to 51 mmHg, p < 0.001), but did not change PaO with FiO = 1.0 (MD 7 mmHg, 95% CI from - 12 to 49 mmHg, p = 0.313). Moreover, alveolar recruitment was not correlated with improvement of oxygenation or venous admixture. In patients with severe COVID-19 pneumonia, higher PEEP resulted in limited alveolar recruitment. These findings suggest limiting PEEP strictly to the values necessary to maintain oxygenation, thus avoiding the use of higher PEEP levels.

Aged

Cohort Studies

COVID-19 - complications

COVID-19 - diagnostic imaging

COVID-19 - epidemiology

COVID-19 - physiopathology

Female

Humans

Italy - epidemiology

Male

Middle Aged

Pneumonia, Viral - diagnostic imaging

Pneumonia, Viral - therapy

Pneumonia, Viral - virology

Positive-Pressure Respiration

Pulmonary Alveoli - diagnostic imaging

Pulmonary Alveoli - physiology

Severity of Illness Index

Tomography, X-Ray Computed

Treatment Outcome

Details

Title: Subtitle: Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia
Creators: Lorenzo Ball - University of Genoa
Chiara Robba - Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
Lorenzo Maiello - University of Genoa
Jacob Herrmann - Harvard University
Sarah E Gerard - Harvard University
Yi Xin - University of Pennsylvania
Denise Battaglini - Ospedale Policlinico San Martino
Iole Brunetti - Ospedale Policlinico San Martino
Giuseppe Minetti - Ospedale Policlinico San Martino
Sara Seitun - Ospedale Policlinico San Martino
Antonio Vena - Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
Daniele Roberto Giacobbe - Ospedale Policlinico San Martino
Matteo Bassetti - University of Genoa
Patricia R M Rocco - Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Maurizio Cereda - University of Pennsylvania
Lucio Castellan - Ospedale Policlinico San Martino
Nicolò Patroniti - University of Genoa
Paolo Pelosi - Universidade Federal do Rio de Janeiro
GECOVID (GEnoa COVID-19) group
Resource Type: Journal article
Publication Details: Critical care (London, England), Vol.25(1), pp.81-81
DOI: 10.1186/s13054-021-03477-w
PMID: 33627160
PMCID: PMC7903929
NLM abbreviation: Crit Care
ISSN: 1364-8535
eISSN: 1466-609X
Grant note: E-26/210.181/ 2020 / Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro 401700/2020-8 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) T32 HL144461 / NHLBI NIH HHS
Language: English
Date published: 02/24/2021
Academic Unit: Roy J. Carver Department of Biomedical Engineering
Record Identifier: 9984306747802771

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