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Open Access 01-12-2022 | Acute Respiratory Distress-Syndrome | Research

External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study

Authors: Luca Bastia, Emanuele Rezoagli, Marcello Guarnieri, Doreen Engelberts, Clarissa Forlini, Francesco Marrazzo, Stefano Spina, Gabriele Bassi, Riccardo Giudici, Martin Post, Giacomo Bellani, Roberto Fumagalli, Laurent J. Brochard, Thomas Langer

Published in: Annals of Intensive Care | Issue 1/2022

Abstract

Background

External chest-wall compression (ECC) is sometimes used in ARDS patients despite lack of evidence. It is currently unknown whether this practice has any clinical benefit in patients with COVID-19 ARDS (C-ARDS) characterized by a respiratory system compliance (C_rs) < 35 mL/cmH₂O.

Objectives

To test if an ECC with a 5 L-bag in low-compliance C-ARDS can lead to a reduction in driving pressure (DP) and improve gas exchange, and to understand the underlying mechanisms.

Methods

Eleven patients with low-compliance C-ARDS were enrolled and underwent 4 steps: baseline, ECC for 60 min, ECC discontinuation and PEEP reduction. Respiratory mechanics, gas exchange, hemodynamics and electrical impedance tomography were recorded. Four pigs with acute ARDS were studied with ECC to understand the effect of ECC on pleural pressure gradient using pleural pressure transducers in both non-dependent and dependent lung regions.

Results

Five minutes of ECC reduced DP from baseline 14.2 ± 1.3 to 12.3 ± 1.3 cmH₂O (P < 0.001), explained by an improved lung compliance. Changes in DP by ECC were strongly correlated with changes in DP obtained with PEEP reduction (R² = 0.82, P < 0.001). The initial benefit of ECC decreased over time (DP = 13.3 ± 1.5 cmH₂O at 60 min, P = 0.03 vs. baseline). Gas exchange and hemodynamics were unaffected by ECC. In four pigs with lung injury, ECC led to a decrease in the pleural pressure gradient at end-inspiration [2.2 (1.1–3) vs. 3.0 (2.2–4.1) cmH₂O, P = 0.035].

Conclusions

In C-ARDS patients with C_rs < 35 mL/cmH₂O, ECC acutely reduces DP. ECC does not improve oxygenation but it can be used as a simple tool to detect hyperinflation as it improves C_rs and reduces P_pl gradient. ECC benefits seem to partially fade over time. ECC produces similar changes compared to PEEP reduction.

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Title: External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study
Authors: Luca Bastia
Emanuele Rezoagli
Marcello Guarnieri
Doreen Engelberts
Clarissa Forlini
Francesco Marrazzo
Stefano Spina
Gabriele Bassi
Riccardo Giudici
Martin Post
Giacomo Bellani
Roberto Fumagalli
Laurent J. Brochard
Thomas Langer
Publication date: 01-12-2022
Publisher: Springer International Publishing
Keywords: Acute Respiratory Distress-Syndrome
COVID-19
Published in: Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-022-01008-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study

Abstract

Background

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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