Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation and hemodynamics in patients with SARS-Cov-2 associated Acute Respiratory Distress Syndrome

Bonny, Vincent; Janiak, Vincent; Spadaro, Savino; Pinna, Andréa; Demoule, Alexandre; Dres, Martin

doi:10.1186/s13054-020-03311-9

Cited by 13 publications

(19 citation statements)

References 6 publications

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“…(29-34), the model provides a heterogeneous disease profile distributed across 100 gas-exchanging compartments implementing (a) vasodilation leading to hyperperfusion of collapsed lung regions, (b) disruption of hypoxic pulmonary vasoconstriction, with hypoperfusion of normally aerated lung regions (c) disruption of alveolar gas-exchange due to the effects of pneumonitis, and (d) heightened vascular resistance due to the presence of microthrombi, while maintaining relatively well preserved lung compliance and gas volumes. It replicates closely the levels of ventilation-perfusion mismatch and hypoxemia (34, 35), as well as the lack of responsiveness to PEEP (36-38), that has been documented in some patients with COVID-19; see (28) and the supplementary file for full details.…”

Section: Methodssupporting

confidence: 75%

High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational modelling study

Weaver

Das

Saffaran

et al. 2021

Preprint

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There is ongoing controversy regarding the potential for increased respiratory effort to generate patient self-inflicted lung injury (P-SILI) in spontaneously breathing patients with COVID-19 acute respiratory failure. However, direct clinical evidence linking increased inspiratory effort to lung injury is scarce. We adapted a recently developed computational simulator that replicates distinctive features of COVID-19 pathophysiology to quantify the mechanical forces that could lead to P-SILI at different levels of respiratory effort. In accordance with recent data, the simulator was calibrated to represent a spontaneously breathing COVID-19 patient with severe hypoxaemia (SaO2 80.6%) and relatively well-preserved lung mechanics (lung compliance of 47.5 ml/cmH2O), being treated with supplemental oxygen (FiO2 = 100%). Simulations were conducted at tidal volumes (VT) and respiratory rates (RR) of 7 ml/kg and 14 breaths/min (representing normal respiratory effort) and at VT/RR of 15/14, 7/20, 15/20, 10/30, 12/30, 10/35, 12/35, 10/40, 12/40 ml/kg / breaths/min. Lung compliance was unaffected by increased VT but decreased significantly at higher RR. While oxygenation improved, significant increases in multiple indicators of the potential for lung injury were observed at all higher VT/RR combinations tested. Pleural pressure swing increased from 10.1 cmH2O at baseline to 30 cmH2O at VT/RR of 15 ml/kg / 20 breaths/min and to 54.6 cmH2O at 12 ml/kg / 40 breaths/min. Dynamic strain increased from 0.3 to 0.49 at VT/RR of 12 ml/kg / 30 breaths/min, and to 0.6 at 15 ml/kg / 20 breaths/min. Mechanical power increased from 7.83 J/min to 17.7 J/min at VT/RR of 7 ml/kg / 20 breaths/min, and to 240.5 7 J/min at 12 ml/kg / 40 breaths/min. Our results suggest that the forces generated during increased inspiratory effort in severe COVID-19 are compatible with the development of P-SILI. If conventional oxygen therapy or non-invasive ventilation is ineffective in reducing respiratory effort, control of driving and transpulmonary pressures with invasive ventilation may reduce the risk of P-SILI and allow time for the resolution of the underlying condition.

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Section: Methodssupporting

confidence: 75%

High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational modelling study

Weaver

Das

Saffaran

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…All the changes requested are implemented in this correction, and the original article [1] has been corrected.…”

Section: The Acknowledgments Section Should Readmentioning

confidence: 99%

“…The correct author group with affiliations should read: Vincent Bonny 1* , Vincent Janiak 2,3 , Savino Spadaro 4,5 , Andrea Pinna 2 , Alexandre Demoule 1,6 and Martin Dres 1,6 1 Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, The sentence currently reads: PEEP decremental was not associated with significant changes in gasses exchanges but was associated with a significant decrease in plateau pressure and driving pressure and with a significant decrease in end-inspiratory and in end-expiratory transpulmonary pressures.…”

mentioning

confidence: 99%

Correction to: Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation, and hemodynamics in patients with SARS-Cov-2-associated Acute Respiratory Distress Syndrome

et al. 2020

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“…Patients with COVID-19 viral pneumonia, before the secondary endothelial alveolar injury, have the same response to PEEP that focal-ARDS. A high PEEP value, may provoke deleterious effects, so that the harm derived on the lung exceed the benefit [4] . Setting PEEP according to PaO2/FiO2 is questionnable when the disease is related to a viral pneumonia associated with a diffuse endotheliopathy and thrombosis, two phenomenon that may explain deep hypoxemia with sub-normal lung mechanics.…”

mentioning

confidence: 99%

The meaning of the Low Optimum End-Expiratory Airway Pressure value found in some COVID-19 patients

Bendjelid

Constantin

2021

Anaesthesia Critical Care & Pain Medicine

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Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation and hemodynamics in patients with SARS-Cov-2 associated Acute Respiratory Distress Syndrome

Cited by 13 publications

References 6 publications

High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational modelling study

High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational modelling study

Correction to: Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation, and hemodynamics in patients with SARS-Cov-2-associated Acute Respiratory Distress Syndrome

The meaning of the Low Optimum End-Expiratory Airway Pressure value found in some COVID-19 patients

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