The combination of different ventilatory strategies and its effects on respiratory mechanics and gas exchange in patients under mechanical ventilation with acute respiratory distress syndrome secondary to coronavirus-19 has been scarcely described.
Investigation in mechanically ventilated patients with with acute respiratory distress
syndrome (ARDS) secondary to coronavirus-19 (COVID-19) is emerging due to presumed
differences with typical ARDS from other origin. Considering these issues, the effects of
ventilatory strategies such as positive end expiratory pressure, end inspiratory pause and
fraction of inspired oxygen on respiratory mechanics and gas exchange must be studied in
order to characterize the behavior of COVID-19 ARDS during invasive mechanical ventilation
and choose the best combination of ventilatory settings.
In this study the investigators will evaluate the changes in respiratory mechanics and gas
exchange produced by low and high positive end expiratory pressure, low and high inspired
oxygen fraction and the application of end inspiratory pause during volume controlled
mechanical ventilation.
Other: High PEEP with end inspiratory pause
Applying a PEEP value 10 cmH2O higher than the lower inflection point of the pressure-volume curve of the respiratory system with end inspiratory pause addition in volumen control ventilation
Other: Low PEEP - FiO2 high
Applying a PEEP value equal to the lower inflection point of the pressure-volume curve of the respiratory system with a FiO2 necessary to achieve a SpO2 96-98%
Other: High PEEP without end inspiratory pause
Applying a PEEP value 10 cmH2O higher than the lower inflection point of the pressure-volume curve of the respiratory system without end inspiratory pause addition in volumen control ventilation
Other: Low PEEP - FiO2 low
Applying a PEEP value equal to the lower inflection point of the pressure-volume curve of the respiratory system with a FiO2 necessary to achieve a SpO2 88-92%
Inclusion Criteria:
- Older than 18 years old
- less than 72 hs since ARDS diagnosis
- Moderate to severe ARDS
- central venous catheter and arterial line available
- Need of neuromuscular blocking agents
- Supine position
- Informed consent accepted
- Airway opening pressure lower than 20 cmH2O
Exclusion Criteria:
- RASS target higher than -5
- COPD diagnosis
- Pneumothorax
- Intracraneal Hypertension
- Pregnancy
- Cardiac inssuficiency uncompensated
- Chest wall deformity
- Bronchopleural fistula
- Contraindication to use esophageal manometry
Sanatorio Anchorena San Martin
San Martin, Buenos Aires, Argentina
Investigator: Javier H Dorado, PT
Contact: (054) 1141644262
javierhdorado@gmail.com
Javier H Dorado, PT
(054) 114164 4262
javierhdorado@gmail.com
Joaquin Pérez, PT
(054) 02245 505907
licjoaquinperez@hotmail.com