1
|
Depta F, Török P, G. Miller A, Firment P, Leškanič J, Porubän A, Halaš P, Mandinec S, Filka V, Zajac H, Gentile MA, Zdravkovic M. Programmed multi-level ventilation in COVID-19-related acute respiratory distress syndrome: a multi-center retrospective observational study. J Int Med Res 2022; 50:3000605221101970. [PMID: 35634917 PMCID: PMC9158417 DOI: 10.1177/03000605221101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We evaluated pressure-controlled ventilation (PCV) with multiple programmed levels of positive end expiratory pressure (programmed multi-level ventilation; PMLV) in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Methods We conducted a multicenter, retrospective study from November 2020 to February 2021. PMLV was used with PCV in all patients with intensive care admission until improvement in oxygenation (fraction of inspired oxygen [FiO2] ≤0.50 and oxygen saturation [SpO2] >92%). The observed outcomes were improvement of hypoxemia, length of mechanical ventilation, partial pressure of carbon dioxide (PaCO2) stability, and adverse events. Results Of 188 mechanically ventilated patients with COVID-19-related ARDS, we analyzed 60 patients treated with PMLV. Hypoxemia improved in 55 (92%) patients, as measured by the change in partial pressure of oxygen/FiO2 and SpO2/FiO2 ratios on day 3 versus day 1, and in 32 (66%) ventilated patients on day 7 versus day 3. The median (interquartile range) length of mechanical ventilation for survivors and non-survivors was 8.4 (4.7–14.9) and 6.7 (3.6–10.3) days, respectively. Conclusions PMLV appears to be a safe and effective ventilation strategy for improving hypoxemia in patients with COVID-19-related ARDS. Further studies are needed comparing the PMLV mode with the conventional ARDS ventilatory approach.
Collapse
Affiliation(s)
- Filip Depta
- Department of Anesthesiology and Intensive Care, East Slovak Institute of Cardiovascular Diseases, Slovakia
- Pavol Jozef Šafárik University, Košice, Slovakia
| | - Pavol Török
- Department of Anesthesiology and Intensive Care, East Slovak Institute of Cardiovascular Diseases, Slovakia
- Pavol Jozef Šafárik University, Košice, Slovakia
| | - Andrew G. Miller
- Respiratory Care Services, Duke University Medical Center, Durham, North Carolina, USA
| | - Peter Firment
- Department of Anesthesiology and Intensive Care, FN Hospital J. A. Reimana Prešov, Slovakia
| | - Jozef Leškanič
- Department of Anesthesiology and Intensive Care, Sv. Jakuba Hospital, Bardejov, Slovakia
| | - Adam Porubän
- Department of Anesthesiology and Intensive Care, Liptov Hospital, Liptovský Mikuláš, Slovakia
| | - Pavol Halaš
- Department of Anesthesiology and Intensive Care, Hospital Myjava, Slovakia
| | - Stanislav Mandinec
- Department of Anesthesiology and Intensive Care, Faculty Hospital, Trenčín, Slovakia
| | - Vladimír Filka
- Department of Anesthesiology and Intensive Care, L. Pasteur University Hospital, Košice, Slovakia
| | - Henryk Zajac
- Department of Anesthesiology and Intensive Care, AGEL Hospital, Krompachy, Slovakia
| | | | - Marko Zdravkovic
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia
| |
Collapse
|