Heterogeneity of Ventilation/Perfusion Mismatch at Different Levels of PEEP and in Mechanical Phenotypes of COVID-19 ARDS

被引:8
作者
Scaramuzzo, Gaetano [1 ,2 ]
Karbing, Dan Stieper [3 ]
Fogagnolo, Alberto [2 ]
Mauri, Tommaso [4 ,5 ]
Spinelli, Elena [5 ]
Mari, Matilde [1 ]
Turrini, Cecilia [2 ]
Montanaro, Federica [2 ]
Volta, Carlo Alberto [1 ,2 ]
Rees, Stephen Edward [3 ]
Spadaro, Savino [1 ,2 ,6 ]
机构
[1] Univ Ferrara, Dept Translat Med & Romagna, Ferrara, Italy
[2] Azienda Ospedaliera Univ Ferrara, Dept Anesthesia & Intens Care Med, Ferrara, Italy
[3] Aalborg Univ, Dept Hlth Sci & Technol, Aalborg, Denmark
[4] CaGranda Maggiore Policlin Hosp Fdn, Inst Treatment & Res, Dept Anesthesia Crit Care & Emergency, Milan, Italy
[5] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
[6] Azienda Ospedaliera Univ Ferrara, Dept Translat Med, Via Aldo Moro 8, I-44100 Ferrara, Italy
关键词
V; Q? mis- match; COVID-19; ARDS; PEEP; shunt; phenotypes; RESPIRATORY-DISTRESS-SYNDROME; END-EXPIRATORY PRESSURE; LUNG; MODEL; SHUNT; GAS; REPRODUCTION; MORTALITY; THERAPY; TRIAL;
D O I
10.4187/respcare.10242
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: COVID-19-related ARDS is characterized by severe hypoxemia with initially preserved lung compliance and impaired ventilation/perfusion (V /Q) matching. PEEP can increase end-expiratory lung volume, but its effect on V/Q mismatch in COVID-19-related ARDS is not clear. METHODS: We enrolled intubated and mechanically ventilated subjects with COVID-19 ARDS and used the automatic lung parameter estimator (ALPE) to measure V /Q. Respiratory mechanics measurements, shunt, and V/Q mismatch (low V/Q and high V /Q) were collected at 3 PEEP levels (clinical PEEP = intermediate PEEP, low PEEP [clinical -50%], and high PEEP [clinical + 50%]). A mixed-effect model was used to evaluate the impact of PEEP on V /Q. We also investigated if PEEP might have a different effect on V/Q mismatch in 2 different respiratory mechanics phenotypes, that is, high elastance/low compliance (pheno-type H) and low elastance/high compliance (phenotype L). RESULTS: Seventeen subjects with COVID-related ARDS age 66 [60-71] y with a PaO2/FIO2 of 141 +/- 74 mm Hg were studied at low PEEP = 5.6 +/- 2.2 cm H2O, intermediate PEEP = 10.6 +/- 3.8 cm H2O, and high PEEP = 15 +/- 5 cm H2O. Shunt, low V /Q, high V /Q, and alveolar dead space were not significantly influ-enced, on average, by PEEP. Respiratory system compliance decreased significantly when increasing PEEP without significant variation of PaO2/FIO2 (P = .26). In the 2 phenotypes, PEEP had opposite effects on shunt, with a decrease in the phenotype L and an increase in phenotype H (P = .048). CONCLUSIONS: In subjects with COVID-related ARDS placed on invasive me-chanical ventilation for > 48 h, PEEP had a heterogeneous effect on V/Q mismatch and, on aver-age, higher levels were not able to reduce shunt. The subject's compliance could influence the effect of PEEP on V/Q mismatch since an increased shunt was observed in subjects with lower compliance, whereas the opposite occurred in those with higher compliance.
引用
收藏
页码:188 / 198
页数:11
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