Giorgio Bosso, Gennaro Sansone, Martina Papillo, Alessandro Giaquinto, Silvia Orefice, Enrico Allegorico, Claudia Serra, Valentina Minerva, Valentina Mercurio, Francesca Cannavacciuolo, Ferdinando Dello Vicario, Giovanni Porta, Antonio Pagano, Fabio Giuliano Numis
{"title":"接受CPAP治疗的新冠肺炎患者的肺部超声引导PEEP滴定。","authors":"Giorgio Bosso, Gennaro Sansone, Martina Papillo, Alessandro Giaquinto, Silvia Orefice, Enrico Allegorico, Claudia Serra, Valentina Minerva, Valentina Mercurio, Francesca Cannavacciuolo, Ferdinando Dello Vicario, Giovanni Porta, Antonio Pagano, Fabio Giuliano Numis","doi":"10.1515/jbcpp-2023-0165","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP.</p><p><strong>Methods: </strong>This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H<sub>2</sub>O, Group B performed the \"PEEP trial\", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of \"lung pulse\" determining a PaO<sub>2</sub>/FiO<sub>2</sub> increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO<sub>2</sub>/FiO<sub>2</sub>. As safety indicator, the incidence of pneumothorax was collected.</p><p><strong>Results: </strong>Thirty-two patients were enrolled in <b>Group A</b> and 31 in <b>Group B</b>. The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in <b>Group A</b> and 13 (41.9 %) in <b>Group B</b> (p<0.01). Mortality was higher in <b>Group A</b> (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. <b>Group B</b> showed a higher PaO<sub>2</sub>/FiO<sub>2</sub> increase than <b>Group A</b> (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in <b>Group A</b>, none in <b>Group B</b>.</p><p><strong>Conclusions: </strong>Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.</p>","PeriodicalId":15352,"journal":{"name":"Journal of Basic and Clinical Physiology and Pharmacology","volume":" ","pages":"677-682"},"PeriodicalIF":0.0000,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP.\",\"authors\":\"Giorgio Bosso, Gennaro Sansone, Martina Papillo, Alessandro Giaquinto, Silvia Orefice, Enrico Allegorico, Claudia Serra, Valentina Minerva, Valentina Mercurio, Francesca Cannavacciuolo, Ferdinando Dello Vicario, Giovanni Porta, Antonio Pagano, Fabio Giuliano Numis\",\"doi\":\"10.1515/jbcpp-2023-0165\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP.</p><p><strong>Methods: </strong>This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H<sub>2</sub>O, Group B performed the \\\"PEEP trial\\\", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of \\\"lung pulse\\\" determining a PaO<sub>2</sub>/FiO<sub>2</sub> increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO<sub>2</sub>/FiO<sub>2</sub>. As safety indicator, the incidence of pneumothorax was collected.</p><p><strong>Results: </strong>Thirty-two patients were enrolled in <b>Group A</b> and 31 in <b>Group B</b>. The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in <b>Group A</b> and 13 (41.9 %) in <b>Group B</b> (p<0.01). Mortality was higher in <b>Group A</b> (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. <b>Group B</b> showed a higher PaO<sub>2</sub>/FiO<sub>2</sub> increase than <b>Group A</b> (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in <b>Group A</b>, none in <b>Group B</b>.</p><p><strong>Conclusions: </strong>Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.</p>\",\"PeriodicalId\":15352,\"journal\":{\"name\":\"Journal of Basic and Clinical Physiology and Pharmacology\",\"volume\":\" \",\"pages\":\"677-682\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-07-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Basic and Clinical Physiology and Pharmacology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1515/jbcpp-2023-0165\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"Pharmacology, Toxicology and Pharmaceutics\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Basic and Clinical Physiology and Pharmacology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1515/jbcpp-2023-0165","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
引用次数: 0
摘要
目的：越来越多的新冠肺炎患者接受持续气道正压（CPAP）治疗。在需要CPAP的新冠肺炎患者中，评估个性化呼气末正压（PEEP）与标准固定式PEEP的临床效果。方法：这是一项单中心、前瞻性、随机的临床研究。将63名患有低氧性呼吸衰竭和双侧肺炎的新冠肺炎患者随机分为两组：A组接受CPAP，固定PEEP为10 cm H2O，B组进行了“PEEP试验”，该试验包括评估最佳PEEP，定义为在确定PaO2/FiO2增加的“肺脉冲”回声出现之前的PEEP值。主要结果是复合住院死亡率+插管，次要结果是PaO2/FiO2的百分比增加。作为安全性指标，收集了发生率。结果：A组32例，B组31例。两组患者的临床特征和实验室参数具有可比性。主要转归发生在36例（57.1 %) 患者：23（71.8 %) A组和13组（41.9 %) B组（p A组（53.1对19.3 %, p B组显示出高于a组的PaO2/FiO2增加（34.9对13.1 %, p A组，B组无。结论：肺超声引导下PEEP试验与接受CPAP治疗的新冠肺炎患者的低死亡率相关。确定最佳PEEP有助于增加氧合并降低并发症的发生率。
Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP.
Objectives: An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP.
Methods: This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H2O, Group B performed the "PEEP trial", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of "lung pulse" determining a PaO2/FiO2 increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO2/FiO2. As safety indicator, the incidence of pneumothorax was collected.
Results: Thirty-two patients were enrolled in Group A and 31 in Group B. The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in Group A and 13 (41.9 %) in Group B (p<0.01). Mortality was higher in Group A (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. Group B showed a higher PaO2/FiO2 increase than Group A (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in Group A, none in Group B.
Conclusions: Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.
期刊介绍：
The Journal of Basic and Clinical Physiology and Pharmacology (JBCPP) is a peer-reviewed bi-monthly published journal in experimental medicine. JBCPP publishes novel research in the physiological and pharmacological sciences, including brain research; cardiovascular-pulmonary interactions; exercise; thermal control; haematology; immune response; inflammation; metabolism; oxidative stress; and phytotherapy. As the borders between physiology, pharmacology and biochemistry become increasingly blurred, we also welcome papers using cutting-edge techniques in cellular and/or molecular biology to link descriptive or behavioral studies with cellular and molecular mechanisms underlying the integrative processes. Topics: Behavior and Neuroprotection, Reproduction, Genotoxicity and Cytotoxicity, Vascular Conditions, Cardiovascular Function, Cardiovascular-Pulmonary Interactions, Oxidative Stress, Metabolism, Immune Response, Hematological Profile, Inflammation, Infection, Phytotherapy.
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