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In this study, the authors evaluated the use of electrical impedance tomography (EIT) in patients with COVID-19–related ARDS. They then compared EIT-titrated PEEP with the level that would have been assigned by published ARDS PEEP tables. They found that EIT-titrated PEEP levels corresponded to higher PEEP table values; notably, however, their population had a high BMI. Additionally, transpulmonary pressures and driving pressures did not increase.
This is an interesting study that provides support for a potential additional measure for PEEP titration, although further studies are necessary to validate this method.
– Morgan Soffler, MD
This abstract is available on the publisher's site.
Coronavirus disease (COVID-19) spreads rapidly and has already resulted in severe burden to hospitals and ICUs worldwide. Early reports described progression to acute respiratory distress syndrome (ARDS) in 29% of cases.
It is unknown how to titrate positive end-expiratory pressure (PEEP) in patients with ARDS. Patient survival improved if higher PEEP successfully recruited atelectatic lung tissue. However, excessive PEEP caused alveolar overdistention, resulting in reduced patient survival. Therefore, PEEP should be personalized to maximize alveolar recruitment and minimize the amount of alveolar overdistention. Electrical impedance tomography (EIT) provides a reliable bedside approach to detect both alveolar overdistention and alveolar collapse.
We describe a case series of patients with COVID-19 and moderate to severe ARDS in whom EIT was applied to personalize PEEP based on the lowest relative alveolar overdistention and collapse. Subsequently, we compared this PEEP level with the PEEP that could have been set according to the lower or higher PEEP–FiO2 table from the ALVEOLI trial. These early experiences may help clinicians to titrate PEEP in patients with COVID-19 and ARDS.