Lung Recruitability in COVID-19–associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study

Pan, Chun; Chen, Lu; Lü, Cong; Zhang, Wei; Xia, Jia An; Sklar, Michael C.; Du, Bin; Brochard, Laurent; Qiu, Haibo

doi:10.1164/rccm.202003-0527le

Cited by 277 publications

(353 citation statements)

References 7 publications

Supporting

Mentioning

303

Contrasting

Unclassified

Order By: Relevance

“…Our observations extend those initially reported in three small cases series showing essentially low or variable potentials of recruitment with PEEP [4][5][6]. In the recently reported Chinese series of 12 SARS-Cov-2-associated ARDS, all patients were initially considered as poorly recruitable based on the same method to measure R/I ratio [4]. Interestingly, repetitive measurements showed that some of them became recruitable potentially depending on the time course evolution of the disease and the respiratory treatment they received (notably prone positioning).…”

Section: Data Are Presented As Median [Interquartile Range]supporting

confidence: 92%

“…The present small cases series is the first to describe early and complete respiratory mechanics evaluation in SARS-Cov-2-associated ARDS consistent with the "2 phenotypes" model proposed by Gattinoni et al [16]. Our observations extend those initially reported in three small cases series showing essentially low or variable potentials of recruitment with PEEP [4][5][6]. In the recently reported Chinese series of 12 SARS-Cov-2-associated ARDS, all patients were initially considered as poorly recruitable based on the same method to measure R/I ratio [4].…”

Section: Data Are Presented As Median [Interquartile Range]supporting

confidence: 90%

“…Authors concluded that R/I ratio is feasible, even in the constrained Covid-19 environment and may allow to guide individual titration of PEEP to limit potential harmful effects expected with high PEEP in poorly recruitable patients. Most (75%) of these patients received NIV or HFNC before intubation for a median of 5 [IQR, [4][5][6][7] days. This could lead to patient self-inflicted lung injury [17] that may explain, at least in part, their low respiratory system compliance (around 20 mL/cmH 2 O) after intubation.…”

Section: Data Are Presented As Median [Interquartile Range]mentioning

confidence: 99%

“…In a large series of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2)-associated respiratory failure, the majority of intubated patients were ventilated with high level of positive endexpiratory pressure (PEEP) [1]. However, information about specific individual characteristics of respiratory mechanics of SARS-Cov-2-associated ARDS remains very limited [4][5][6]. Based on their experience during the crisis, some authors suggested that part of the SARS-Cov-2 associated ARDS may present relatively high respiratory system compliance (C RS ) and poor recruitability with PEEP, contrasting with severe hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome

Beloncle

Pavlovsky

Desprez

et al. 2020

Ann. Intensive Care

106

View full text Add to dashboard Cite

Background: A large proportion of patients with a SARS-Cov-2-associated respiratory failure develop an acute respiratory distress syndrome (ARDS). It has been recently suggested that SARS-Cov-2-associated ARDS may differ from usual non-SARS-Cov-2-associated ARDS by higher respiratory system compliance (C RS ), lower potential for recruitment with positive end-expiratory pressure (PEEP) contrasting with severe shunt fraction. The purpose of the study was to systematically assess respiratory mechanics and recruitability in SARS-Cov-2-associated ARDS. Methods:Gas exchanges, C RS and hemodynamics were assessed at 2 levels of PEEP (15 cmH 2 O and 5 cmH 2 O) within 36 h (day1) and from 4 to 6 days (day 5) after intubation. The recruited volume was computed as the difference between the volume expired from PEEP 15 to 5 cmH 2 O and the volume predicted by compliance at PEEP 5 cmH 2 O (or above airway opening pressure). The recruitment-to-inflation (R/I) ratio (i.e. the ratio between the recruited lung compliance and C RS at PEEP 5 cmH 2 O) was used to assess lung recruitability. A R/I ratio value higher than or equal to 0.5 was used to define highly recruitable patients. Results:The R/I ratio was calculated in 25 of the 26 enrolled patients at day 1 and in 15 patients at day 5. At day 1, 16 (64%) were considered as highly recruitable (R/I ratio median [interquartile range] 0.7 [0.55-0.94]) and 9 (36%) were considered as poorly recruitable (R/I ratio 0.41 [0.31-0.48]). The PaO 2 /FiO 2 ratio at PEEP 15 cmH 2 O was higher compared to PEEP 5 cmH 2 O only in highly recruitable patients (173 [139-236] vs 135 [89-167] mmHg; p < 0.01). Neither PaO 2 /FiO 2 or C RS measured at PEEP 15 cmH 2 O or at PEEP 5 cmH 2 O nor changes in PaO 2 /FiO 2 or C RS in response to PEEP changes allowed to identify highly or poorly recruitable patients. Conclusion:In this series of 25 patients with SARS-Cov-2 associated ARDS, 64% were considered as highly recruitable and only 36% as poorly recruitable based on the R/I ratio performed on the day of intubation. This observation suggests that a systematic R/I ratio assessment may help to guide initial PEEP titration to limit harmful effect of unnecessary high PEEP in the context of Covid-19 crisis.

show abstract

Section: Data Are Presented As Median [Interquartile Range]supporting

confidence: 92%

Section: Data Are Presented As Median [Interquartile Range]supporting

confidence: 90%

Section: Data Are Presented As Median [Interquartile Range]mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome

Beloncle

Pavlovsky

Desprez

et al. 2020

Ann. Intensive Care

106

View full text Add to dashboard Cite

show abstract

“…Plateau pressures and driving pressures are often low and respiratory system compliance relatively normal compared to the ARDS patient [1]. Many physicians use high positive end-expiratory pressure (PEEP) for patients with COVID-19 although the potential for recruitment is often low [1,2]. We fear that the high compliance of the respiratory system in combination with high PEEP will lead to hyperinflation, high dead space, and potentially right ventricular failure.…”

Section: To the Editormentioning

confidence: 99%

Advanced respiratory monitoring in COVID-19 patients: use less PEEP!

2020

View full text Add to dashboard Cite

Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?

Telias

Katira

Brochard

2020

JAMA

Self Cite

113

View full text Add to dashboard Cite

to opioid reduction. 9 A service that likely has substantial harms for some, and small benefit for few under the most generous assumptions, should be held to the same standards as other preventive services, regardless of whether it is a laboratory test that leads to an invasive treatment or a series of questions that lead to counseling and referral.Screening for drug use is reasonable to consider in clinical practice, but it is not evidence-based for improving health. These observations should serve as an important call for the development and study of new strategies to identify and address drug use in ways that can reduce related harms of such use.

show abstract

Lung Recruitability in COVID-19–associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study

Cited by 277 publications

References 7 publications

Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome

Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome

Advanced respiratory monitoring in COVID-19 patients: use less PEEP!

Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?

Contact Info

Product

Resources

About