High PEEP/low FiO2 ventilation is associated with lower mortality in COVID–19

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2024-07-11 DOI:10.1016/j.jcrc.2024.154854

Robin L. Goossen , Relin van Vliet , Lieuwe D.J. Bos , Laura A. Buiteman-Kruizinga , Markus W. Hollman , Sheila N. Myatra , Ary Serpa Neto , Peter E. Spronk , Meta C.E. van der Woude , David M.P. van Meenen , Frederique Paulus , Marcus J. Schultz

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引用次数: 0

Abstract

Rationale

The positive end–expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID–19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO₂ ventilation on outcomes during the second wave in the Netherlands.

Methods

Retrospective observational study of invasively ventilated COVID–19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90–day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality.

Results

This analysis included 790 COVID–ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46–0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings.

Conclusions

High PEEP ventilation was associated with improved ICU survival in patients with COVID–ARDS.

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高 PEEP/低 FiO2 通气与 COVID-19 死亡率降低有关

理由对冠状病毒 2019（COVID-19）急性呼吸窘迫综合征（ARDS）患者的呼气末正压（PEEP）策略仍存在争议。大多数研究源于大流行的最初几波。在此，我们旨在评估高 PEEP/低 FiO2 通气对荷兰第二波疫情中的预后的影响。方法对第二波疫情中接受有创通气的 COVID-19 患者进行回顾性观察研究。根据 ARDS 网络表格，根据患者是接受高 PEEP 通气还是低 PEEP 通气进行分类。主要结果是 ICU 死亡率，次要结果包括住院和 90 天死亡率、通气时间和住院时间以及肾损伤发生率。该分析包括790名COVID-ARDS患者。ICU 出院时，142 名高 PEEP 患者中有 32 人（22.5%）死亡，848 名低 PEEP 患者中有 254 人（39.2%）死亡（HR 0.66 [0.46-0.96]; P = 0.03）。高 PEEP 与次要结果的改善有关。结论高 PEEP 通气与 COVID-ARDS 患者 ICU 存活率的改善有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.