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. 2022 Mar 16;11(6):1639.
doi: 10.3390/jcm11061639.

Bedside Selection of Positive End Expiratory Pressure by Electrical Impedance Tomography in Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation Support: A Comparison between COVID-19 ARDS and ARDS from Other Etiologies

Michela Di Pierro  1 , Marco Giani  1   2 , Alfio Bronco  2 , Francesca Maria Lembo  1 , Roberto Rona  2 , Giacomo Bellani  1   2 , Giuseppe Foti  1   2
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Bedside Selection of Positive End Expiratory Pressure by Electrical Impedance Tomography in Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation Support: A Comparison between COVID-19 ARDS and ARDS from Other Etiologies

Michela Di Pierro et al. J Clin Med. .

Abstract

Background: The interest in protective ventilation strategies and individualized approaches for patients with severe illness on veno venous extracorporeal support has increased in recent years. Wide heterogeneity exists among patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and ARDS from other etiologies (NC-ARDS). EIT is a useful tool for the accurate analysis of regional lung volume distribution and allows for a tailored ventilatory setting. The aim of this work is to retrospectively describe the results of EIT assessments performed in patients C-ARDS and NC-ARDS undergoing V-V ECMO support.

Methods: A clinical EIT-guided decremental PEEP trail was conducted for all patients included in the study and mechanically ventilated.

Results: 12 patients with C-ARDS and 12 patients with NC-ARDS were included in the study for a total of 13 and 18 EIT evaluations, respectively. No significant differences in arterial blood gas, respiratory parameters, and regional ventilation before and after the EIT exam were recorded. The subset of patients with NC-ARDS whose EIT exam led to PEEP modification was characterized by a lower baseline compliance compared with the C-ARDS group: 18 (16-28) vs. 27 (24-30) (p = 0.04). Overdistension significantly increased at higher steps only for the NC-ARDS group. A higher percentage of overdistension was described in patients with NC-ARDS when compared with patients with C-ARDS.

Conclusions: EIT is feasible in patients with COVID-19-associated ARDS on veno-venous extracorporeal support and may help in tailoring the PEEP setting. Overall, severe COVID-19-related ARDS presents respiratory characteristics similar to severe "classical" NC-ARDS. However, C-ARDS is associated with a lower risk of overdistension at a higher PEEP level compared with NC-ARDS.

Keywords: ARDS; COVID-19; ECMO; acute respiratory distress syndrome; mechanical ventilation.

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Conflict of interest statement

All authors declare no conflicts of interest related to the current work. Alfio Bronco, Roberto Rona, and Giuseppe Foti received fees from Draeger Medical for lecturing, and Giacomo Bellani received fees from Draeger Medical for lecturing and consultancy.

Figures

Figure 1
Figure 1
Overdistension (OD) and de-recruitment (DR) at different PEEP levels in the C-ARDS and NC-ARDS groups. Data are synthesized as means, and error bars represent standard deviation. * OD: p < 0.05 versus C-ARDS.
See this image and copyright information in PMC

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