A clinical study on mechanical ventilation PEEP setting for traumatic ARDS patients guided by esophageal pressure

Abstract

OBJECTIVE:

This study aims to explore whether positive end-expiratory pressure (PEEP) guided by esophageal pressure is better than the acute respiratory distress syndrome network (ARDSNet) during the treatment of traumatic acute respiratory distress syndrome (ARDS) patients.

SUGGESTIONS:

The use of the oxygenation method of inhaled oxygen concentration titration PEEP is suggested.

METHODS:

This study takes traumatic ARDS patients as the research object. The data of 23 patients were included in this study. The patients were randomly divided into two groups: the esophageal pressure titration PEEP group ( $n=$ 12), and the ARDSNet (PEEP-FiO ${}_2$ table) titration PEEP group ( $n=$ 11). All patients were given mechanical ventilation, and changes in oxygenation index, respiratory mechanics, hemodynamics and inflammatory reaction index were recorded when titrating the best PEEP with the two methods on the current day of grouping and after grouping for 24, 48 and 72 hours.

RESULTS:

The PEEP titration value in the esophageal pressure group was 12 $\pm$ 4 cm H ${}_2$ O, and this value was significantly higher than the PEEP titration value in the ARDSNet group (8 $\pm$ 3 cm H ${}_2$ O) ( $P<$ 0.05). The end-expiratory transpulmonary pressure of titrating the best PEEP with the esophageal pressure method and ARDSNet method is 0.5 $\pm$ 0.7 cm H ${}_2$ O vs. $-$ 1.1 $\pm$ 3.3 cm H ${}_2$ O ( $P<$ 0.05). When titrating the best PEEP with the esophageal pressure method, lung tissue compliance, end-expiratory transpulmonary pressure and the oxygenation index are higher than those obtained through the ARDSNet method ( $P<$ 0.05). (2) In the esophageal pressure group, with the extension of treatment time, high-sensitivity C reactive protein (hs-CRP) and procalcitonin (PCT) exhibited a trend of significant decrease ( $P<$ 0.05). In the ARDSNet group, with the extension of treatment time, PCT also exhibited a significant decrease ( $P<$ 0.05), while the decrease in hs-CRP was not significant ( $P>$ 0.05). After comparing these two treatment groups at each monitoring time point, we found that the difference in hs-CRP and PCT was not statistically significant ( $P>$ 0.05). During the 72-hour treatment of interleukin-6 (IL-6) and interleukin-8 (IL-8), we found that these two were significantly lower in the esophageal pressure group than in the ARDSNet group ( $P<$ 0.05).

CONCLUSIONS:

The PEEP selection of mechanical ventilation of patients with traumatic ARDS guided by transpulmonary pressure and calculated by measuring intrapleural pressure can realize the individual adjustment of PEEP, identify ARDS patients benefiting from high PEEP, and provide a PEEP setting that can better meet the needs of traumatic patients.