Programmed multi-level ventilation in COVID-19-related acute respiratory distress syndrome: a multi-center retrospective observational study

Author:

Depta Filip12ORCID,Török Pavol12,G. Miller Andrew3,Firment Peter4,Leškanič Jozef5,Porubän Adam6,Halaš Pavol7,Mandinec Stanislav8,Filka Vladimír9,Zajac Henryk10,Gentile Michael A.11,Zdravkovic Marko12

Affiliation:

1. Department of Anesthesiology and Intensive Care, East Slovak Institute of Cardiovascular Diseases, Slovakia

2. Pavol Jozef Šafárik University, Košice, Slovakia

3. Respiratory Care Services, Duke University Medical Center, Durham, North Carolina, USA

4. Department of Anesthesiology and Intensive Care, FN Hospital J. A. Reimana Prešov, Slovakia

5. Department of Anesthesiology and Intensive Care, Sv. Jakuba Hospital, Bardejov, Slovakia

6. Department of Anesthesiology and Intensive Care, Liptov Hospital, Liptovský Mikuláš, Slovakia

7. Department of Anesthesiology and Intensive Care, Hospital Myjava, Slovakia

8. Department of Anesthesiology and Intensive Care, Faculty Hospital, Trenčín, Slovakia

9. Department of Anesthesiology and Intensive Care, L. Pasteur University Hospital, Košice, Slovakia

10. Department of Anesthesiology and Intensive Care, AGEL Hospital, Krompachy, Slovakia

11. IPM Chirana Inc., Durham, North Carolina, USA

12. Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia

Abstract

Objective We evaluated pressure-controlled ventilation (PCV) with multiple programmed levels of positive end expiratory pressure (programmed multi-level ventilation; PMLV) in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Methods We conducted a multicenter, retrospective study from November 2020 to February 2021. PMLV was used with PCV in all patients with intensive care admission until improvement in oxygenation (fraction of inspired oxygen [FiO2] ≤0.50 and oxygen saturation [SpO2] >92%). The observed outcomes were improvement of hypoxemia, length of mechanical ventilation, partial pressure of carbon dioxide (PaCO2) stability, and adverse events. Results Of 188 mechanically ventilated patients with COVID-19-related ARDS, we analyzed 60 patients treated with PMLV. Hypoxemia improved in 55 (92%) patients, as measured by the change in partial pressure of oxygen/FiO2 and SpO2/FiO2 ratios on day 3 versus day 1, and in 32 (66%) ventilated patients on day 7 versus day 3. The median (interquartile range) length of mechanical ventilation for survivors and non-survivors was 8.4 (4.7–14.9) and 6.7 (3.6–10.3) days, respectively. Conclusions PMLV appears to be a safe and effective ventilation strategy for improving hypoxemia in patients with COVID-19-related ARDS. Further studies are needed comparing the PMLV mode with the conventional ARDS ventilatory approach.

Publisher

SAGE Publications

Subject

Biochemistry (medical),Cell Biology,Biochemistry,General Medicine

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