Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease

作者：Xuesong Liu, Xiao Liu, Xiao Liu, Dongdong Liu, Jue Meng, Dongdong Liu, Yongbo Huang, Ling Sang, Yonghao Xu, Zhiheng Xu, Weiqun He, Sibei Chen, Rong Zhang, Xiaoqing Liu, Xiaoqing Liu, Yimin Li · 发表于：Critical Care · 年份：2022 · DOI：10.1186/s13054-022-04201-y · 被引用次数：70 · 研究领域：Respiratory Support and Mechanisms、Sepsis Diagnosis and Treatment、Neonatal Respiratory Health Research

Abstract Background Chronic obstructive pulmonary disease (COPD) is one of most common comorbidities in acute respiratory distress syndrome (ARDS). There are few specific studies on the appropriate ventilation strategy for patients with ARDS comorbid with COPD, especially regarding on positive end-expiratory pressure (PEEP) titration. Methods To compare the respiratory mechanics in mechanical ventilated ARDS patients with or without COPD and to determine whether titration of PEEP based on electrical impedance tomography (EIT) is superior to the ARDSnet protocol. This is a single center, perspective, repeated measure study. ARDS patients requiring mechanical ventilation who were admitted to the intensive care unit between August 2017 and December 2020 were included. ARDS patients were divided according to whether they had COPD into a COPD group and a non-COPD group. Respiratory mechanics, gas exchange, and hemodynamics during ventilation were compared between the groups according to whether the PEEP level was titrated by EIT or the ARDSnet protocol. Results A total of twenty-seven ARDS patients including 14 comorbid with and 13 without COPD who met the study eligibility criteria were recruited. The PEEP levels titrated by EIT and the ARDSnet protocol were lower in the COPD group than in the non-COPD group (6.93 ± 1.69 cm H 2 O vs. 12.15 ± 2.40 cm H 2 O, P < 0.001 and 10.43 ± 1.20 cm H 2 O vs. 14.0 ± 3.0 cm H 2 O, P < 0.001, respectively). In the COPD group, the PEEP leve...