Factors related to adjusting positive end-expiratory pressure guided by transpulmonary pressure in acute respiratory distress syndrome: a prospective analysis of Vietnamese patients

Abstract

Critically ill patients often face elevated chest wall weight and increased pleural pressures. Positive transpul-monary end-expiratory pressure (PL-exp) indicative of chest wall mechanical stiffness of the chest wall and has been evi-denced to improve blood oxygenation and respiratory mechanics. Our study focuses on the incidence of positive PL-exp in initial Positive End-Expiratory Pressure (PEEP) settings and to identify factors for adjustments of PEEP adjustments in Vietnamese patients with Acute Respiratory Distress Syndrome (ARDS). The study was conducted on 46 patients with moderate to severe ARDS from November 2021 to October 2023, in a tertiary hospital in Vietnam. Patients were divided into two groups based on PL-exp: the Constant PEEP group (PL-exp > 0 cm H2O) and the Adjusted PEEP group (PL-exp > 10 or < 0 cm H2O). The primary outcome measured was the incidence of positive PL-exp. Secondary outcomes included the number of ventilator days, length of hospital stay, and in-hospital mortal-ity. This study included 46 patients with a mean age of 49.8 years and a Body Mass Index (BMI) of 24.7 kg/m2. Of those patients, 76.1% had moderate ARDS, and 23.9% severe ARDS. The incidence of positive PL-exp was 41.3%. The factors significantly related to the included BMI and initial PEEP settings. Our study demonstrated an incidence of positive PL-exp of 41.3%. Adjusting PEEP settings may be benefi-cial for ARDS patients with high BMI within Vietnamese populations. Further research is necessary to optimize and individ-ualize PEEP settings in ARDS patients to improve clinical outcomes.