Sang Ling, Zheng Xia, Zhao Zhanqi, Zhong Min, Jiang Li, Huang Yongbo, Liu Xiaoqing, Li Yimin, Zhang Dingyu
State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
Front Med (Lausanne). 2021 Jan 22;7:603943. doi: 10.3389/fmed.2020.603943. eCollection 2020.
Patients with coronavirus disease 2019 (COVID-19) may develop severe acute respiratory distress syndrome (ARDS). The aim of the study was to explore the lung recruitability, individualized positive end-expiratory pressure (PEEP), and prone position in COVID-19-associated severe ARDS. Twenty patients who met the inclusion criteria were studied retrospectively (PaO/FiO 68.0 ± 10.3 mmHg). The patients were ventilated under volume-controlled mode with tidal volume of 6 mL/kg predicted body weight. The lung recruitability was assessed the improvement of PaO, PaCO, and static respiratory system compliance (C) from low to high PEEP (5-15 cmHO). Patients were considered recruitable if two out of three parameters improved. Subsequently, PEEP was titrated according to the best C. The patients were turned to prone position for further 18-20 h. For recruitability assessment, average value of PaO was slightly improved at PEEP 15 cmHO (68.0 ± 10.3 vs. 69.7 ± 7.9 mmHg, baseline vs. PEEP 15 cmHO; = 0.31). However, both PaCO and C worsened (PaCO: 72.5 ± 7.1 vs. 75.1 ± 9.0 mmHg; < 0.01. C: 17.5 ± 3.5 vs. 16.6 ± 3.9 ml/cmHO; = 0.05). Only four patients (20%) were considered lung recruitable. Individually titrated PEEP was higher than the baseline PEEP (8.0 ± 2.1 cmHO vs. 5 cmHO, < 0.001). After 18-20 h of prone positioning, investigated parameters were significantly improved compared to the baseline (PaO: 82.4 ± 15.5 mmHg. PaCO: 67.2 ± 6.4 mmHg. C: 20.6 ± 4.4 ml/cmHO. All < 0.001 vs. baseline). Lung recruitability was very low in COVID-19-associated severe ARDS. Individually titrated PEEP and prone positioning might improve lung mechanics and blood gasses.
2019冠状病毒病（COVID-19）患者可能会发展为严重急性呼吸窘迫综合征（ARDS）。本研究的目的是探讨COVID-19相关严重ARDS患者的肺可复张性、个体化呼气末正压（PEEP）及俯卧位通气情况。对20例符合纳入标准的患者进行回顾性研究（动脉血氧分压/吸入氧浓度为68.0±10.3 mmHg）。患者采用容量控制模式通气，潮气量为6 mL/kg预计体重。从低水平PEEP（5 - 15 cmH₂O）到高水平PEEP评估肺可复张性，观察动脉血氧分压、动脉血二氧化碳分压及静态呼吸系统顺应性（C）的改善情况。若三项参数中有两项改善，则认为肺具有可复张性。随后，根据最佳顺应性滴定PEEP。患者转为俯卧位通气18 - 20小时。对于可复张性评估，在PEEP为15 cmH₂O时，动脉血氧分压平均值略有改善（基线时为68.0±10.3 mmHg，PEEP 15 cmH₂O时为69.7±7.9 mmHg；P = 0.31）。然而，动脉血二氧化碳分压和顺应性均恶化（动脉血二氧化碳分压：72.5±7.1 mmHg对75.1±9.0 mmHg；P < 0.01。顺应性：17.5±3.5对16.6±3.9 ml/cmH₂O；P = 0.05）。只有4例患者（20%）被认为肺具有可复张性。个体化滴定的PEEP高于基线PEEP（8.0±2.1 cmH₂O对5 cmH₂O，P < 0.001）。俯卧位通气18 - 20小时后，与基线相比，各观察参数均有显著改善（动脉血氧分压：82.4±15.5 mmHg。动脉血二氧化碳分压：67.2±6.4 mmHg。顺应性：20.6±4.4 ml/cmH₂O。与基线相比，P均< 0.001）。COVID-19相关严重ARDS患者的肺可复张性非常低。个体化滴定PEEP和俯卧位通气可能改善肺力学和血气情况。
