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Title: Association of early positive end-expiratory pressure settings with ventilator-free days in patients with coronavirus disease 2019 acute respiratory distress syndrome: A secondary analysis of the Practice of VENTilation in COVID-19 study.
Austin Authors: Valk, Christel M A;Tsonas, Anissa M;Botta, Michela;Bos, Lieuwe D J;Pillay, Janesh;Serpa Neto, Ary ;Schultz, Marcus J;Paulus, Frederique
Affiliation: Department of Intensive Care & Laboratory of Experimental Intensive Care and Anaesthesiology (LEICA), Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria, Australia
Data Analytics Research and Evaluation (DARE) Centre
Nuffield Department of Medicine, Oxford University, Oxford, UK
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
Issue Date: 1-Dec-2021
Date: 2021-07-07
Publication information: European Journal of Anaesthesiology 2021; 38(12): 1274-1283
Abstract: There is uncertainty about how much positive end-expiratory pressure (PEEP) should be used in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). To investigate whether a higher PEEP strategy is superior to a lower PEEP strategy regarding the number of ventilator-free days (VFDs). Multicentre observational study conducted from 1 March to 1 June 2020. Twenty-two ICUs in The Netherlands and 933 invasively ventilated COVID-19 ARDS patients. Patients were categorised retrospectively as having received invasive ventilation with higher (n=259) or lower PEEP (n=674), based on the high and low PEEP/FIO2 tables of the ARDS Network, and using ventilator settings and parameters in the first hour of invasive ventilation, and every 8 h thereafter at fixed time points during the first four calendar days. We also used propensity score matching to control for observed confounding factors that might influence outcomes. The primary outcome was the number of VFDs. Secondary outcomes included distant organ failures including acute kidney injury (AKI) and use of renal replacement therapy (RRT), and mortality. In the unmatched cohort, the higher PEEP strategy had no association with the median [IQR] number of VFDs (2.0 [0.0 to 15.0] vs. 0.0 [0.0 to 16.0] days). The median (95% confidence interval) difference was 0.21 (-3.34 to 3.78) days, P = 0.905. In the matched cohort, the higher PEEP group had an association with a lower median number of VFDs (0.0 [0.0 to 14.0] vs. 6.0 [0.0 to 17.0] days) a median difference of -4.65 (-8.92 to -0.39) days, P = 0.032. The higher PEEP strategy had associations with higher incidence of AKI (in the matched cohort) and more use of RRT (in the unmatched and matched cohorts). The higher PEEP strategy had no association with mortality. In COVID-19 ARDS, use of higher PEEP may be associated with a lower number of VFDs, and may increase the incidence of AKI and need for RRT. Practice of VENTilation in COVID-19 is registered at, NCT04346342.
DOI: 10.1097/EJA.0000000000001565
Journal: European Journal of Anaesthesiology
PubMed URL: 34238782
Type: Journal Article
Appears in Collections:Journal articles

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