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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Acute Respiratory Distress-Syndrome | Research

PEEP titration in moderate to severe ARDS: plateau versus transpulmonary pressure

Authors: Marie Bergez, Nicolas Fritsch, David Tran-Van, Tahar Saghi, Tan Bounkim, Ariane Gentile, Philippe Labadie, Bruno Fontaine, Alexandre Ouattara, Hadrien Rozé

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

Background

Although lung protection with low tidal volume and limited plateau pressure (Pplat) improves survival in acute respiratory distress syndrome patients (ARDS), the best way to set positive end-expiratory pressure (PEEP) is still debated.

Methods

This study aimed to compare two strategies using individual PEEP based on a maximum Pplat (28–30 cmH2O, the Express group) or on keeping end-expiratory transpulmonary pressure positive (0–5 cmH2O, PLexpi group). We estimated alveolar recruitment (Vrec), end-expiratory lung volume and alveolar distension based on elastance-related end-inspiratory transpulmonary pressure (PL,EL).

Results

Nineteen patients with moderate to severe ARDS (PaO2/FiO2 < 150 mmHg) were included with a baseline PEEP of 7.0 ± 1.8 cmH2O and a PaO2/FiO2 of 91.2 ± 31.2 mmHg. PEEP and oxygenation increased significantly from baseline with both protocols; PEEP Express group was 14.2 ± 3.6 cmH2O versus 16.7 ± 5.9 cmH2O in PLexpi group. No patient had the same PEEP with the two protocols. Vrec was higher with the latter protocol (299 [0 to 875] vs. 222 [47 to 483] ml, p = 0.049) and correlated with improved oxygenation (R2 = 0.45, p = 0.002). Two and seven patients in the Express and PL,expi groups, respectively, had PL,EL > 25 cmH2O.

Conclusions

There is a great heterogeneity of PLexpi when Pplat is used to titrate PEEP but with limited risk of over-distension. A PEEP titration for a moderate positive level of PLexpi might slightly improve alveolar recruitment and oxygenation but increases the risk of over-distension in one-third of patients.
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Metadata
Title
PEEP titration in moderate to severe ARDS: plateau versus transpulmonary pressure
Authors
Marie Bergez
Nicolas Fritsch
David Tran-Van
Tahar Saghi
Tan Bounkim
Ariane Gentile
Philippe Labadie
Bruno Fontaine
Alexandre Ouattara
Hadrien Rozé
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0554-3

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