Di Pierro Michela, Giani Marco, Bronco Alfio, Lembo Francesca Maria, Rona Roberto, Bellani Giacomo, Foti Giuseppe
School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy.
Department of Emergency and Intensive Care, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy.
J Clin Med. 2022 Mar 16;11(6):1639. doi: 10.3390/jcm11061639.
The interest in protective ventilation strategies and individualized approaches for patients with severe illness on veno venous extracorporeal support has increased in recent years. Wide heterogeneity exists among patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and ARDS from other etiologies (NC-ARDS). EIT is a useful tool for the accurate analysis of regional lung volume distribution and allows for a tailored ventilatory setting. The aim of this work is to retrospectively describe the results of EIT assessments performed in patients C-ARDS and NC-ARDS undergoing V-V ECMO support.
A clinical EIT-guided decremental PEEP trail was conducted for all patients included in the study and mechanically ventilated.
12 patients with C-ARDS and 12 patients with NC-ARDS were included in the study for a total of 13 and 18 EIT evaluations, respectively. No significant differences in arterial blood gas, respiratory parameters, and regional ventilation before and after the EIT exam were recorded. The subset of patients with NC-ARDS whose EIT exam led to PEEP modification was characterized by a lower baseline compliance compared with the C-ARDS group: 18 (16-28) vs. 27 (24-30) ( = 0.04). Overdistension significantly increased at higher steps only for the NC-ARDS group. A higher percentage of overdistension was described in patients with NC-ARDS when compared with patients with C-ARDS.
EIT is feasible in patients with COVID-19-associated ARDS on veno-venous extracorporeal support and may help in tailoring the PEEP setting. Overall, severe COVID-19-related ARDS presents respiratory characteristics similar to severe "classical" NC-ARDS. However, C-ARDS is associated with a lower risk of overdistension at a higher PEEP level compared with NC-ARDS.
近年来，对于接受静脉-静脉体外支持的重症患者，保护性通气策略和个体化方法的关注度有所增加。新型冠状病毒肺炎相关急性呼吸窘迫综合征（C-ARDS）患者与其他病因所致急性呼吸窘迫综合征（NC-ARDS）患者之间存在广泛的异质性。电阻抗断层成像（EIT）是准确分析肺区域容积分布的有用工具，可实现通气设置的个性化。本研究的目的是回顾性描述在接受V-V体外膜肺氧合（ECMO）支持的C-ARDS和NC-ARDS患者中进行EIT评估的结果。
对纳入研究并接受机械通气的所有患者进行了临床EIT引导下的递减呼气末正压（PEEP）试验。
本研究纳入了12例C-ARDS患者和12例NC-ARDS患者，分别进行了13次和18次EIT评估。EIT检查前后的动脉血气、呼吸参数和区域通气均无显著差异。EIT检查导致PEEP调整的NC-ARDS患者亚组的基线顺应性低于C-ARDS组：18（16-28） vs. 27（24-30）（P = 0.04）。仅NC-ARDS组在较高PEEP水平时过度扩张显著增加。与C-ARDS患者相比，NC-ARDS患者的过度扩张百分比更高。
EIT在接受静脉-静脉体外支持的新型冠状病毒肺炎相关ARDS患者中是可行的，可能有助于调整PEEP设置。总体而言，重症新型冠状病毒肺炎相关ARDS呈现出与重症“经典”NC-ARDS相似的呼吸特征。然而，与NC-ARDS相比，C-ARDS在较高PEEP水平时过度扩张的风险较低。
