Brief Report
Version 1
Preserved in Portico This version is not peer-reviewed
Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!
Version 1
: Received: 15 April 2020 / Approved: 16 April 2020 / Online: 16 April 2020 (13:24:29 CEST)
How to cite: Roesthuis, L.; van den Berg, M.; van der Hoeven, H. Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!. Preprints 2020, 2020040275 (doi: 10.20944/preprints202004.0275.v1). Roesthuis, L.; van den Berg, M.; van der Hoeven, H. Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!. Preprints 2020, 2020040275 (doi: 10.20944/preprints202004.0275.v1).
Abstract
With the emergence of COVID-19 we are confronted with a new clinical picture of acute respiratory distress syndrome in the intensive care unit. In the majority of patients, the respiratory mechanics are very different from the “normal” ARDS patient. We measured transpulmonary pressure and dead space ventilation to assess the effects of high and low PEEP levels on lung compliance and ventilation-perfusion mismatching. Advanced respiratory mechanics were assessed in 14 patients. Compared to ARDS patients, lung compliance was relatively high (61 ± 5 mL/cmH2O). COVID-19 patients had high dead space ventilation and gas exchange impairment (Bohr 52 ± 3%; Enghoff modification 67 ± 2%; ventilatory ratio 2.24 ± 0.23). we show that higher PEEP levels decrease lung compliance and in most cases increase dead space ventilation, indicating that high PEEP levels probably cause hyperinflation in patients with COVID-19. We suggest using prone position for an extended period of time, and apply lower PEEP levels as much as possible.
Subject Areas
COVID-19; ARDS; PEEP; mechanical ventilation; transpulmonary pressure
Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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