Abstract
Background: SARS-CoV2 pneumonia with respiratory failure may evolve to ARDS. The effects of high PEEP on respiratory compliance varies in different patients. Our study is based on the high accurancy and sensitivity of Lung Ultrasound (LUS) in evaluating the heterogeneous distribution of aeration loss, and use of LUS to individualize PEEP titration to produce the best lung aeration.
Methods: Retrospective trial on two cohorts of patients (15+15) with SARS-CoV2 ARDS mild-to-moderate(according to Berlin Criteria), aged 18 to 80 y.o. In Group I(GI) PEEP titration was LUS guided, in Group II(GII) titration was SpO2-guided. In GI LUS score was calculated dividing lungs in six regions per hemithorax. Patients were treated with NIV or CPAP Helmet. In GII FiO2 was initially set at 40% and increased if target oxygenation was not met. In GI PEEP was set at 5 cmH2O and guided by LUS aeration. Cases were managed by PEEP values from 7.5-15 cmH2O. Determination of optimal PaO2/FiO2 was the primary outcome. Secondary outcomes were adverse event: incidence of barotrauma/pneumothorax/pneumomediastinum, haemodynamics (MAP and HR), time spent on NIV/ CPAP, length of stay, weaning categories, and mortality at day 28.
Results: P/F ratio was 282±38.6 in GI, and 243±43.2 in GII. We didn’t detect significant statistical differences between the two groups in terms of mortality (6.2% in Gi vs 6.8% in GII) nor in time to weaning (5±6 in GI vs 16±4.5 in GII). In-stead there were fewer AE in GI vs GII. Length of stay was reduced with mean value of 4.3 days.
Conclusions: Compared to SpO2-guided PEEP titration, LUS-based titration was associated with favorable effects on rate of adverse events and length of hospital stay.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 3850.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
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