Factors related to adjusting positive end-expiratory pressure guided by transpulmonary pressure in acute respiratory distress syndrome: a prospective analysis of Vietnamese patients
Tóm tắt
Introduction: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).
Methods: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.
Results: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.
Conclusions: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.
