Lung ultrasound-guided PEEP titration in COVID–19 patients treated with CPAP
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Giorgio Bosso
,
Gennaro Sansone
Abstract
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.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
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Articles in the same Issue
- Frontmatter
- Editorials
- Deiodination and tumor progression: the interplay between thyroid hormones intracellular activation and the androgen signal
- The intricate role of glutamine in pathophysiological contexts
- Reviews
- Zebrafish as a model organism – can a fish mimic human?
- Phytocompounds and their molecular targets in immunomodulation: a review
- Original Articles
- Host–parasite relationship modulates the effect of African mistletoe leaves on the cholinergic, monoaminergic and carbohydrate hydrolyzing enzymes in fruit fly
- Behavioral and biochemical investigations to explore the efficacy of quercetin and folacin in experimental diabetes induced vascular endothelium dysfunction and associated dementia in rats
- Chronic exposure of industrial grade calcium carbide and ethylene glycol exert genotoxic effect in Wistar albino rats
- A four-year review of uterine rupture at a secondary health facility in Okitipupa, Southwest Nigeria
- Increased nitric oxide availability worsens the cardiac performance during early re-perfusion period in adult rats
- Safety evaluation of an antimalarial herbal product from Andrographis paniculata (AS201-01) in healthy volunteers
- Tobacco use and clinical leukoplakia lesions among south Indian tribes
- Carcinogen sodium arsenite disrupts antioxidant and redox homeostasis in Drosophila melanogaster
- No association of the common Asian mitochondrial DNA haplogroups with lung cancer in East Indian population
- Cardioprotective effect of Justicia gendarussa on doxorubicin induced toxicity in mice
- Lung ultrasound-guided PEEP titration in COVID–19 patients treated with CPAP
- Short Communication
- Effects of the gaseous signalling molecule nitroxyl (HNO) on myenteric neurons governing intestinal motility
