AUTHOR=Gibot Sébastien , Conrad Marie , Courte Guilhem , Cravoisy Aurélie 

TITLE=Positive End-Expiratory Pressure Setting in COVID-19-Related Acute Respiratory Distress Syndrome: Comparison Between Electrical Impedance Tomography, PEEP/FiO2 Tables, and Transpulmonary Pressure

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.720920

DOI=10.3389/fmed.2021.720920

ISSN=2296-858X

ABSTRACT=<p><bold>Introduction:</bold> The best way to titrate the positive end-expiratory pressure (PEEP) in patients suffering from acute respiratory distress syndrome is still matter of debate. Electrical impedance tomography (EIT) is a non-invasive technique that could guide PEEP setting based on an optimized ventilation homogeneity.</p><p><bold>Methods:</bold> For this study, we enrolled the patients with 2019 coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS), who required mechanical ventilation and were admitted to the ICU in March 2021. Patients were monitored by an esophageal catheter and a 32-electrode EIT device. Within 48 h after the start of mechanical ventilation, different levels of PEEP were applied based upon PEEP/FiO<sub>2</sub> tables, positive end-expiratory transpulmonary (P<sub>L</sub>)/ FiO2 table, and EIT. Respiratory mechanics variables were recorded.</p><p><bold>Results:</bold> Seventeen patients were enrolled. PEEP values derived from EIT (PEEP<sub>EIT</sub>) were different from those based upon other techniques and has poor in-between agreement. The PEEP<sub>EIT</sub> was associated with lower plateau pressure, mechanical power, transpulmonary pressures, and with a higher static compliance (Crs) and homogeneity of ventilation.</p><p><bold>Conclusion:</bold> Personalized PEEP setting derived from EIT may help to achieve a more homogenous distribution of ventilation. Whether this approach may translate in outcome improvement remains to be investigated.</p>