基于氧合的呼气末正压（PEEP）表与以驱动压力为导向的PEEP滴定法在新型冠状病毒肺炎（COVID-19）所致重症急性呼吸综合征患者中的比较

Comparison of PEEP tables based on oxygenation vs. driving pressure-guided PEEP titration in patients with severe acute respiratory syndrome due to COVID-19.

作者信息

de Aquino de Moura Karolinny Borinelli, do Rosário Mariana Berger, Rihl Marcos Frata, Victorino Josué Almeida, Wawrzeniak Iuri Christmann

机构信息

Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

出版信息

J Crit Care. 2025 Oct;89:155146. doi: 10.1016/j.jcrc.2025.155146. Epub 2025 Jun 23.

DOI:10.1016/j.jcrc.2025.155146

PMID:40554846

Abstract

PURPOSE

To evaluate the positive end-expiratory pressure (PEEP) values with decremental PEEP titration based on driving pressure (ΔP) were different in comparison with PEEP-FiO2 tables in patients with Severe Acute Respiratory Syndrome due to COVID-19 (CARDS).

METHODS

Retrospective cohort study at academic ICU in Brazil with adults with SARS due to COVID-19. The PEEP titration obtained by Best-ΔP was compared with values from PEEP-FiO2 tables.

RESULTS

A total of 91 patients were included (141 titrations), with a median PaO2/FiO2 of 133 (97-170). The PEEP titration by ΔP was similar to the ARDSnet table (p = 0.83) and different from the LOVs and ALVEOLI tables (p < 0.001). The subgroup of patients with body mass index (BMI) > 30 kg/m2 was different (n = 73, p < 0.001) in all FiO2-tables and best ΔP .

CONCLUSIONS

The PEEP by titration based on ΔP was similar to the ARDSnet low PEEP table, both being different from the other tables. In obese patients, the PEEP found by titration was significantly different in all methods evaluated in this study.

摘要

目的

评估基于驱动压（ΔP）进行递减呼气末正压（PEEP）滴定所获得的PEEP值，与新型冠状病毒肺炎（COVID-19）所致重症急性呼吸综合征（CARDS）患者的PEEP-FiO₂表格相比是否存在差异。

方法

在巴西一家学术重症监护病房对因COVID-19导致严重急性呼吸综合征（SARS）的成年患者进行回顾性队列研究。将通过最佳ΔP获得的PEEP滴定值与PEEP-FiO₂表格中的值进行比较。

结果

共纳入91例患者（141次滴定），动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）中位数为133（97 - 170）。通过ΔP进行的PEEP滴定与ARDSnet表格相似（p = 0.83），与LOVs和ALVEOLI表格不同（p < 0.001）。体重指数（BMI）> 30 kg/m²的患者亚组在所有FiO₂表格和最佳ΔP方面均存在差异（n = 73，p < 0.001）。