机构：[1]State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health,The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China[2]Department of Critical Care Medicine, TheFirst Affiliated Hospital of Zhejiang University, Hangzhou, China浙江大学医学院附属第一医院[3]Department of Biomedical Engineering, Fourth MilitaryMedical University, Xi’an, China[4]Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany,[5]Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China[6]Department of Critical CareMedicine, Xuanwu Hospital, Capital Medical University, Beijing, China首都医科大学宣武医院[7]Research Center for Translational Medicine, WuhanJinyintan Hospital, Wuhan, China[8]Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology andWuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
Background: Patients with coronavirus disease 2019 (COVID-19) may develop severe acute respiratory distress syndrome (ARDS). The aim of the study was to explore the lung recruitability, individualized positive end-expiratory pressure (PEEP), and prone position in COVID-19-associated severe ARDS. Methods: Twenty patients who met the inclusion criteria were studied retrospectively (PaO2/FiO(2) 68.0 +/- 10.3 mmHg). The patients were ventilated under volume-controlled mode with tidal volume of 6 mL/kg predicted body weight. The lung recruitability was assessed via the improvement of PaO2, PaCO2, and static respiratory system compliance (C-stat) from low to high PEEP (5-15 cmH(2)O). Patients were considered recruitable if two out of three parameters improved. Subsequently, PEEP was titrated according to the best C-stat. The patients were turned to prone position for further 18-20 h. Results: For recruitability assessment, average value of PaO2 was slightly improved at PEEP 15 cmH(2)O (68.0 +/- 10.3 vs. 69.7 +/- 7.9 mmHg, baseline vs. PEEP 15 cmH(2)O; p = 0.31). However, both PaCO2 and C-stat worsened (PaCO2: 72.5 +/- 7.1 vs. 75.1 +/- 9.0 mmHg; p < 0.01. C-stat: 17.5 +/- 3.5 vs. 16.6 +/- 3.9 ml/cmH(2)O; p = 0.05). Only four patients (20%) were considered lung recruitable. Individually titrated PEEP was higher than the baseline PEEP (8.0 +/- 2.1 cmH(2)O vs. 5 cmH(2)O, p < 0.001). After 18-20 h of prone positioning, investigated parameters were significantly improved compared to the baseline (PaO2: 82.4 +/- 15.5 mmHg. PaCO2: 67.2 +/- 6.4 mmHg. C-stat: 20.6 +/- 4.4 ml/cmH(2)O. All p < 0.001 vs. baseline). Conclusions: Lung recruitability was very low in COVID-19-associated severe ARDS. Individually titrated PEEP and prone positioning might improve lung mechanics and blood gasses.
基金：
National Science and Technology Major Project [2017ZX10204401, 2020ZX09201001]; Special Project for Emergency of the Ministry of Science and Technology [2020YFC0845100, 2020YFC0841300]; Special Project of Guangdong Science and Technology Department [2020B111105001]; Science and Technology Program of Guangzhou, China [202008040003]; Natural Science Foundation of Guangdong Province, ChinaNational Natural Science Foundation of Guangdong Province [2020A1515011459]
第一作者机构：[1]State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health,The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
共同第一作者：
通讯作者：
通讯机构：[7]Research Center for Translational Medicine, WuhanJinyintan Hospital, Wuhan, China[8]Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology andWuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
推荐引用方式(GB/T 7714)：
Sang Ling,Zheng Xia,Zhao Zhanqi,et al.Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study[J].FRONTIERS IN MEDICINE.2021,7:doi:10.3389/fmed.2020.603943.
APA：
Sang, Ling,Zheng, Xia,Zhao, Zhanqi,Zhong, Min,Jiang, Li...&Zhang, Dingyu.(2021).Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study.FRONTIERS IN MEDICINE,7,
MLA：
Sang, Ling,et al."Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study".FRONTIERS IN MEDICINE 7.(2021)
