PEEP Titration to Minimize Driving Pressure in Subjects With ARDS: A Prospective Physiological Study.
BACKGROUND: Observational studies report that lower driving pressure (ie, the difference between plateau pressure and PEEP) is associated with improved survival in patients with ARDS and may be a key mediator of lung-protective ventilation strategies. The primary objective of this study was to chara...
| Published in: | Respiratory Care Vol. 65; no. 5; pp. 583 - 590 |
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| Main Authors: | , , , , |
| Format: | CEU research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
May2020
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143178316&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143178316 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2020 vid: 65 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 143178316 143178316 143178316 10.4187/respcare.07102 143178316 ppf: 583 ppct: 7 formats: fmt: @attributes: type: P tig: atl: PEEP Titration to Minimize Driving Pressure in Subjects With ARDS: A Prospective Physiological Study. aug: au: Sahetya, Sarina K. Hager, David N. Stephens, R. Scott Needham, Dale M. Brower, Roy G. affil: Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland sug: subj: Positive End-Expiratory Pressure Methods Respiration, Artificial Methods Respiratory Distress Syndrome, Acute Therapy Human Education, Continuing (Credit) Funding Source Prospective Studies Pilot Studies Maryland Academic Medical Centers Tidal Volume Analysis of Variance Repeated Measures Data Analysis Software Adult Middle Age APACHE (Acute Physiology and Chronic Health Evaluation) Clinical Assessment Tools Male Female Descriptive Statistics Ventilator-Induced Lung Injury Prevention and Control Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: BACKGROUND: Observational studies report that lower driving pressure (ie, the difference between plateau pressure and PEEP) is associated with improved survival in patients with ARDS and may be a key mediator of lung-protective ventilation strategies. The primary objective of this study was to characterize reductions in driving pressure that could be achieved through changes in PEEP. METHODS: In this prospective physiological pilot study, 10 subjects with ARDS were placed on PEEP according to the ARDS Network Lower PEEP/FIO2 Table. PEEP was adjusted in small increments and decrements above and below this initial PEEP, and driving pressure was measured at each PEEP level. Subsequently, PEEP was set at the level resulting in the lowest driving pressure, and driving pressure was measured after 1, 5, 15, and 30 min to assess stability over time at constant PEEP. RESULTS: All subjects had ARDS with a median (interquartile range [IQR]) PaO2/FIO2 of 116 (98–132) at enrollment. Median (IQR) driving pressure at baseline was 14 (13–17) cm H2O. After PEEP titration, median driving pressure decreased to 13 (12–14) cm H2O. The largest reduction in driving pressure was 4 cm H2O. Two subjects had no change in driving pressure at multiple PEEP levels. To achieve the lowest driving pressure, final PEEP was increased in 6 subjects and decreased in 4 subjects from the baseline PEEP prescribed by the ARDS Network Lower PEEP/FIO2 Table. Driving pressure reached equilibrium within 1–5 min and remained stable for 30 min following PEEP titration. CONCLUSIONS: PEEP titration had a variable effect in changing driving pressure across this small sample of ARDS subjects. In some subjects, PEEP was decreased from values given in the ARDS Network Lower PEEP/FIO2 Table to minimize driving pressure. Changes in driving pressure stabilized within a few minutes of PEEP titration. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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