Irie Yuhei, Izutani Yoshito, Noake Junta, Ninomiya Shun, Kastumura Mami, Nakashio Maiko, Maruyama Junichi, Nakamura Yoshihiko, Ishikura Hiroyasu
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Am J Emerg Med. 2025 Jul;93:73-79. doi: 10.1016/j.ajem.2025.03.050. Epub 2025 Mar 27.
Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO) in patients with COVID-19 undergoing invasive mechanical ventilation.
We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO table) and a limited PEEP group (maximum PEEP of <10 cmHO) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.
Patients in the ordinary PEEP group (n = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (n = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.
Limiting the maximum PEEP to <10 cmHO may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.
严重急性呼吸综合征冠状病毒2可导致急性呼吸窘迫综合征，需要长时间进行有创机械通气。然而，2019冠状病毒病（COVID-19）患者在接受有创机械通气时会发生气压伤。我们评估了对于接受有创机械通气的COVID-19患者，限制最大呼气末正压（PEEP）是否比使用PEEP/吸入氧分数（FiO）能更有效地预防气压伤。
我们回顾性纳入了在本中心符合诊断标准的患者；在重症监护病房住院期间，将他们分为普通PEEP组（PEEP/较高FiO表）和限制PEEP组（最大PEEP<10 cmH₂O）。我们将评估机械通气的最大呼吸机变量，并将限制PEEP以抑制气压伤作为主要结局。
普通PEEP组（n = 34）的患者比限制PEEP组（n = 27）的患者年龄显著更大，体重指数更高。普通PEEP组的最大PEEP和最大吸气峰压显著高于限制PEEP组。普通PEEP组的气压伤发生率显著高于限制PEEP组。
将最大PEEP限制在<10 cmH₂O可能会预防接受有创机械通气的COVID-19患者发生气压伤。
