Top

Published in:

Open Access 01-12-2020 | Severe Acute Respiratory Syndrome Coronavirus | Letter to the Editor

Transpulmonary pressures in obese and non-obese COVID-19 ARDS

Authors: Mehdi Mezidi, Florence Daviet, Paul Chabert, Sami Hraiech, Laurent Bitker, Jean-Marie Forel, Hodane Yonis, Ines Gragueb, Francois Dhelft, Laurent Papazian, Jean-Christophe Richard, Christophe Guervilly

Published in: Annals of Intensive Care | Issue 1/2020

Abstract

Background

Data on respiratory mechanics of COVID-19 ARDS patients are scarce. Respiratory mechanics and response to positive expiratory pressure (PEEP) may be different in obese and non-obese patients.

Methods

We investigated esophageal pressure allowing determination of transpulmonary pressures (PL ) and elastances (EL) during a decremental PEEP trial from 20 to 6 cm H₂O in a cohort of COVID-19 ARDS patients.

Results

Fifteen patients were investigated, 8 obese and 7 non-obese patients. PEEP ≥ 16 cm H₂O for obese patients and PEEP ≥10 cm H₂O for non-obese patients were necessary to obtain positive expiratory P_L. Change of PEEP did not alter significantly ΔP_L or elastances in obese patients. However, in non-obese patients lung EL and ΔP_L increased significantly with PEEP increase. Chest wall EL was not affected by PEEP variations in both groups.

Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity. 2020. https://doi.org/10.1002/oby.22831.CrossRefPubMed

Akoumianaki E, Maggiore SM, Valenza F, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014 Mar 1;189(5):520–31. https://doi.org/10.1164/rccm.201312-2193CI.ReviewPubMed PMID: 24467647.CrossRefPubMed

Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. https://doi.org/10.1186/s13054-016-1278-5.CrossRefPubMedPubMedCentral

Chiumello D, Marino A, Brioni M, et al. Visual anatomical lung CT scan assessment of lung recruitability. Intensive Care Med. 2013;39(1):66–73. https://doi.org/10.1007/s00134-012-2707-9.CrossRefPubMed

Pan C, Chen L, Lu C, et al. Recruitability in SARS-CoV-2 associated acute respiratory distress syndrome: a single-center, observational study. Am J Respir Crit Care Med. 2020. https://doi.org/10.1164/rccm.202003-0527LE[Epub ahead of print] PubMed PMID: 32200645.CrossRefPubMedPubMedCentral

Beloncle FM, Pavlovsky B, Desprez C, et al. Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome. Ann Intensive Care. 2020;10(1):55. https://doi.org/10.1186/s13613-020-00675-7.CrossRefPubMedPubMedCentral

Haudebourg AF, Perier F, Tuffet S, et al. Respiratory Mechanics of COVID-19 vs. Non-COVID-19 associated acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020. https://doi.org/10.1164/rccm.202004-1226LE.CrossRefPubMedPubMedCentral

Title: Transpulmonary pressures in obese and non-obese COVID-19 ARDS
Authors: Mehdi Mezidi
Florence Daviet
Paul Chabert
Sami Hraiech
Laurent Bitker
Jean-Marie Forel
Hodane Yonis
Ines Gragueb
Francois Dhelft
Laurent Papazian
Jean-Christophe Richard
Christophe Guervilly
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Severe Acute Respiratory Syndrome Coronavirus
Acute Respiratory Distress-Syndrome
COVID-19
Published in: Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-020-00745-w

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Transpulmonary pressures in obese and non-obese COVID-19 ARDS

Abstract

Background

Methods

Results

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Please log in to get access to this content

Other articles of this Issue 1/2020

Diastolic shock index and clinical outcomes in patients with septic shock

Pharmacokinetics of high-dose tigecycline in critically ill patients with severe infections

Response to: 500 mg as bolus followed by an extended infusion of 1500 mg of meropenem every 8 h failed to achieve in one-third of the patients an optimal PK/PD against nonresistant strains of these organisms: is CRRT responsible for this situation?

Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: a post hoc analysis of two prospective cohorts

Early mechanical ventilation in patients with Guillain-Barré syndrome at high risk of respiratory failure: a randomized trial

Acute kidney injury in patients with SARS-CoV-2 infection