The Clinical Effect Of Different PEEP Settings Titrated By Driving Pressure Of ARDS Patients

Objective:To investigate the effects of PEEP settings on respiratory mechanics and hemodynamics in patients with acute respiratory distress syndrome?ARDS?guided by limited driving pressure.Methods:Thirty patients with severely diagnosed ARDS were enrolled in the Intensive Care Unit,Third Hospital of Hebei Medical University from October 2016 to December 2018.They were divided into the guide group?parameters were set according to ARDSnet recommendations?,the oxygenation group?titrate PEEP according to the optimal oxygenation?and the driving pressure group?limit the driving pressure to 13cmH₂O?according to the random number table,10 cases each.The respiratory mechanics indexes?OI,PEEP?,hemodynamic parameters?HR,CO?and therapeutic effect indicators?PVPI,EVLWI,mechanical ventilation time and 28-day mortality?were compared before and after treatment.The data were analyzed by SPSS25.0.Results:The PEEP titrated by guide group,the oxygenation group and the driving pressure group were?10.8±1.40?,?16.7±2.41?,and?14.1±2.92?cmH₂O,respectively,statistically significant?P<0.05?.The oxygenation group could improve the OI value.The difference was statistically significant?P<0.05?between the two groups at 24h,48h.The driving pressure group also improved the OI.There was no statistically significant difference between the oxygenation group and the driving pressure group on OI value at 72h?P>0.05?.The patients'cardiac output in the oxygenation group decreased after enrollment,and the difference was statistically significant compared with the other two groups?P<0.05?.Compared with the guide group?203.6±28.78h?and the oxygenation group?202.5±22.02h?,the driving pressure group?145.3±26.27h?was able to shorten the mechanical ventilation time,and the difference was statistically significant?P<0.05?.There were no significant differences in HR,PVPI,EVLWI and 28-day mortality between the three groups at each time point?P>0.05?.Conclusion:Titrating PEEP based on controlling driving pressure at13cmH₂O can improve ARDS patients'oxygenation function,the hemodynamics of the patient is less affected and the mechanical ventilation time can be shortened.