Introduction
Methods
Patients
Mechanical ventilation settings
PEEP adjustment procedure
EIT assessment
Evaluation of dPaw vs PEEP curve profile
Statistical analysis
Results
Patients’ characteristics | All COVID-19 | J-shaped n = 126 | U-shaped n = 40 | Inverted J-shaped n = 18 | p value |
---|---|---|---|---|---|
Age, years, n = 184 | 60.04 ± 15.89 | 60.37 ± 15.94 | 59.20 ± 17.30 | 59.67 ± 12.68 | 0.915 |
Male, n (%), n = 184 | 127 (69.02%) | 92 (72.44%) | 25 (62.50%) | 10 (55.55%) | 0.160 |
Body mass index, kg/m2, n = 183 | 29.02 ± 6.43 | 27.48 ± 6.65a | 30.16 ± 6.95a,b | 35.89 ± 8.67b | < 0.001 |
Comorbidities, n (%), n = 69 | 44 (63.8%) | 30 (65.2%) | 11 (68.8%) | 3 (42.9%) | 0.500 |
Hypertension, n (%) | 38 (55.1%) | 24 (52.2%) | 11 (68.8%) | 3 (42.9%) | 0.422 |
Diabetes mellitus, n (%) | 29 (42%) | 18 (39.1%) | 8 (50%) | 3 (42.9%) | 0.807 |
SOFA, n = 143 | 5.43 ± 4.03 | 5.17 ± 3.04 | 5.69 ± 3.39 | 6.53 ± 3.06 | 0.262 |
PEEP at baseline n = 114 | 10 (10–14) | 10 (10–14)a,c | 12 (10–15.5)a | 15 (10.5–19.5)c | < 0.05 |
FiO2 at baseline, n (%), n = 184 | 80 (60–100) | 70 (60–100)a | 100 (70–100)a | 95 (60–100) | < 0.05 |
PaCO2 at baseline, mmhg, n = 75 | 51.6 ± 11.9 | 51.4 ± 11.1 | 54.2 ± 13.2 | 47.1 ± 14.4 | 0.410 |
Respiratory rate at baseline, breaths/min, n = 75 | 20 (20–25) | 20 (20–25) | 24 (20–24.5) | 20 (20–20) | 0.170 |
Minute ventilation at baseline, L/min, n = 75 | 8.1 ± 2.0 | 8.3 ± 2.0 | 8.1 ± 1.7 | 6.8 ± 1.7 | 0.180 |
Respiratory mechanics | J-shaped n = 126 | U-shaped n = 40 | Inverted J-shaped n = 18 | p value |
---|---|---|---|---|
Tidal volume, mL/kg of IBW (mean, sd) | 6.03 ± 0.03 | 5.86 ± 0.92 | 5.97 ± 0.14 | 0.098 |
Baseline Crs, mL/cmH2O (mean, sd) | 33.47 ± 7.25a | 29.24 ± 8.70a,b | 25.64 ± 8.45b | < 0.001 |
Baseline dPaw, cmH2O (mean, sd) | 12.65 ± 2.66a | 13.21 ± 3.94a,b | 15.03 ± 3.72b | < 0.05 |
Baseline PaO2/FiO2, mmHg (mean, sd) | 139.32 ± 52.67a | 120.72 ± 57.68a,b | 92.43 ± 40.43b | < 0.05 |
PEEPmin_dPaw, cmH2O (median, IIQ) | 7.52 ± 1.9a,c | 12.2 ± 2.64a,b | 14.6 ± 2.38b,c | < 0.001 |
EIT assessment | N = 28 | N = 12 | N = 1 | |
---|---|---|---|---|
Hyperdistention at the optimal PEEP, % (mean, sd) | 1.58 ± 2.34 | 6.34 ± 10.22 | 1.3 ± 0 | 0.071 |
AUC for hyperdistention, %.cmH2O (mean, sd) | 216.75 ± 81.44a | 116.17 ± 77.53ª | 6.3 ± 0 | < 0.001 |
Collapse at the optimal PEEP, % (mean, sd) | 13.86 ± 13.38 | 10.81 ± 10.38 | 0.0 ± 0 | 0.473 |
AUC for collapse, %.cmH2O (mean, sd) | 96.95 ± 70.40a | 149.42 ± 95.54a | 418 ± 0 | < 0.001 |
EIT optimal PEEP, cmH2O, (mean, sd) | 9.17 ± 2.53a | 12.96 ± 3.29ª | 14.22 ± 0 | < 0.001 |