Evaluation of limiting PEEP effectiveness in preventing barotrauma in critically ill COVID-19 patients: A retrospective study

Abstract

Background

Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO₂) in patients with COVID-19 undergoing invasive mechanical ventilation.

Materials and methods

We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO₂ table) and a limited PEEP group (maximum PEEP of <10 cmH₂O) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.

Results

Patients in the ordinary PEEP group (n = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (n = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.

Conclusions

Limiting the maximum PEEP to <10 cmH₂O may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.