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Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP.

Authors :: Bosso G
Sansone G
Papillo M
Giaquinto A
Orefice S
Allegorico E
Serra C
Minerva V
Mercurio V
Cannavacciuolo F
Dello Vicario F
Porta G
Pagano A
Numis FG
Source :: Journal of basic and clinical physiology and pharmacology [J Basic Clin Physiol Pharmacol] 2023 Jul 20; Vol. 34 (5), pp. 677-682. Date of Electronic Publication: 2023 Jul 20 (Print Publication: 2023).
Publication Year :: 2023
Abstract: Objectives: An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP.<br />Methods: This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H <subscript>2</subscript> O, Group B performed the "PEEP trial", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of "lung pulse" determining a PaO <subscript>2</subscript> /FiO <subscript>2</subscript> increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO <subscript>2</subscript> /FiO <subscript>2</subscript> . As safety indicator, the incidence of pneumothorax was collected.<br />Results: Thirty-two patients were enrolled in Group A and 31 in Group B . The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in Group A and 13 (41.9 %) in Group B (p<0.01). Mortality was higher in Group A (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. Group B showed a higher PaO <subscript>2</subscript> /FiO <subscript>2</subscript> increase than Group A (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in Group A , none in Group B .<br />Conclusions: Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.<br /> (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)