Lung ultrasound- versus FiO2-guided PEEP in ARDS patients

Mai S Salem,Hesham S Eltatawy,Ahmed A Abdelhafez,Salah El-Din I Alsherif

doi:10.1080/11101849.2020.1741253

Abstract

ABSTRACT Background: Although FiO2-determined PEEP is the standard in ARDS management, previous trials failed to show agreement on outcomes. Based on heterogeneous ARDS pathology, we evaluated the effect of LUS-determined PEEP on oxygenation and outcomes. Methods: In this prospective, controlled trial, we randomly assigned 60 patients into LUS-determined PEEP (group l) and FiO2-determined PEEP (group II). LUS-determined PEEP was based on LUS aeration score. Primary outcome was P/F ratio, secondary outcomes were; static compliance, 28-day mortality, duration of MV and length of ICU-stay. Results: P/F ratio was 266 ± 44.5 in group I, 233 ± 53.9 in group II. Static compliance was 54.8 ± 6.6 in group I, 45.9 ± 3.8 in group II. IQR of duration of MV was 4–6 with a median value of 5 in group l, 6–11.7 with a median value of 7.5 in group ll. 28-day mortality was 6.7% in group l, 30% in group ll. The relative risk of mortality in group II is more or less 5 times in group I (RR 4.87 with 95%CI of 1.492–15.893). IQR of organ dysfunction-free days was 16–19 with a median value of 18 in group l, 0–12 with a median value of 10 in group ll. IQR of MV-free days was 22–24 with a median value of 23 in group l, 0–22 with a median value of 20 in group ll. Conclusion: LUS-guided PEEP showed improved oxygenation, compliance and decreased mortality, organ dysfunction, duration of MV and ICU compared with FiO2-guided PEEP.

Highlights

Applying the optimal level of Positive End Expiratory Pressure (PEEP) is the main component in the treatment of Acute Respiratory Distress Syndrome (ARDS) [1]
LUS-guided PEEP showed improved oxygenation, compliance and decreased mortality, organ dysfunction, duration of mechanical ventilation (MV) and ICU compared with FiO2-guided PEEP
ARDS patients in the LUS group were classified into 70% with focal ARDS and 30% with diffuse ARDS (Table 2)

Summary

Introduction

Applying the optimal level of Positive End Expiratory Pressure (PEEP) is the main component in the treatment of Acute Respiratory Distress Syndrome (ARDS) [1]. Optimal PEEP is the value that ensures the best lung recruitment, resulting in enhancement of oxygenation without lung hyperinflation or affection of hemodynamics [2]. There is no gold standard method for optimal PEEP determination [3]. The rationale of our study is based on the fact that LUS can evaluate the heterogeneous distribution of aeration loss in ARDS. We hypothesized that LUS can be used to individualize titration of PEEP to produce the best lung reaeration. FiO2-determined PEEP is the standard in ARDS management, previous trials failed to show agreement on outcomes. Based on heterogeneous ARDS pathology, we evaluated the effect of LUS-determined PEEP on oxygenation and outcomes. Methods: In this prospective, controlled trial, we randomly assigned 60 patients into LUS-. LUS-determined PEEP was based on LUS aeration score. Primary outcome was P/F ratio, secondary outcomes were; static compliance, 28-day mortality, duration of MV and length of ICU-stay

Results

Discussion

Conclusion