PEEP Titrated By Transpulmonary Pressure In Moderate To Severe ARDS Patients

Objective To study the clinical effects of transpulmonary pressure and the best static lung compliance in guiding PEPE titration in patients with moderate to severe ARDS,and to compare the characteristics of the two methods,to provide a reference for clinical application.Methods All patients enrolled were randomly allocated to titrate PEEP by transpulmonary pressure(Ptp group)and the best static lung compliance(Cst group),and both groups were monitored for esophageal pressure.The Ptp group was set to titrate PEEP according to the end-expiratory transpulmonary pressure,and the Cst group was set to titrate PEEP according to the best static lung compliance.The time points of monitoring were baseline,2h,4h,12 h,24h,48 h,and 72h;The monitoring indicators: oxygenation index,respiratory mechanics(PEEP,driving pressure,static lung compliance),and outcome indicators(28-day mortality,mechanical ventilation time,ICU stay time,hospital stay time).Results A total of 33 patients in the intensive care unit(ICU)of Gansu Provincial Hospital were enrolled.There were no differences in the basic characteristics of the two groups at baseline.The study showed that:(1)There were no significant difference on improvement of oxygenation between the Ptp group and the Cst group at 2h-48h(p>0.05),but improvement of oxygenation was significantly better at 72 h in Ptp group(187.39±25.89 vs.156.95±21.63,p=0.001);(2)At 2h-72 h after enrollment,titrated PEEP was significantly higher in the Ptp group than that of the Cst group(p<0.05).(3)At 2h?2h?12h to 72 h,the Cst was significantly better in the Cst group(p<0.05).(4)There were no significant differences between the two groups in 28-day mortality rate,the length of hospital stay,length of ICU stay,and length of ventilation days(p>0.05).(5)stratifying: According to the primary disease of ARDS,it is divided into two subgroups: extrapulmonary ARDS and pulmonary ARDS.In extrapulmonary ARDS subgroup and in Ptp group,oxygenation was improved obviously at 2h to 72 h after enrollment,and there was a statistically significant difference between 48h(155.64±20.52 vs.131.63±16.88,p=0.02)and 72h(195.90 ± 27.27 vs.158.97 ± 34.88,p = 0.02).Conclusions Among patients with moderate to severe ARDS,transpulmonary pressure guided PEEP,compared with the best static lung compliance method,had significant difference in improving oxygenation and no significant difference in death and mechanical ventilation days,but appeared to be suitable for patients with extrapulmonary ARDS.