Study On The Correlation Between PEEP Setting Level And Inhaled Oxygen Concentration In ARDS Patients

Objectives:To investigate whether the PEEP setting level and inhaled oxygen concentration of ARDS patients with mechanical ventilation in the department of critical care medicine of Hebei university hospital conform to the FiO₂-PEEP corresponding scale recommended by ARDS Net,inorder to better regulate the ventilator setting of ARDS patients with mechanical ventilation.Methods:Retrospective analysis was performed on 31 patients diagnosed with ARDS according to the 2012 Berlin standard and treated with invasive ventilation in the department of intensive care medicine of affiliated hospital of Hebei university from January 2014 to December 2019.According to whether the relationship between the setting level of PEEP and the concentration of inhaled oxygen conforms to the FiO₂-PEEP corresponding scale recommended by ARDS Net,it was divided into the standard treatment group and the non-standard treatment group.There were 15 patients in the standard treatment group and 16patients in the non-standard treatment group.Record two groups of patient's age,gender,in time,ARDS etiology,surgical site,postures,ARDS critical degree,APACHE?score,the number of organ failure and ICU length of hospital stay,invasive ventilation days,presence of barotrauma,12th hours mechanical ventilation PEEP,12th hours mechanical ventilation FiO₂,mechanical ventilation gas exchange index?T12?:12th hours PH,FiO₂,PaO₂,PaO₂/FiO₂,PaCO₂,Lac,mechanical ventilation 12th hours based hemodynamic index?T12?:Heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,central venous pressure,noradrenaline dosage.Result:1.Comparison of general clinical data:there was no significant difference in age and gender between the two groups?P>0.05?,and there was no significant difference in the etiology of ARDS,mainly includes severe infection?56.25%vs.40%,P>0.05?,severe acute pancreatitis?31.25%vs.40%,P>0.05?,and trauma?12.5%vs.20%,P>0.05?.The surgical site of the patients involved in the operation was mainly in the abdomen,and the body position was all in the 30°supine position with the height of the head.ARDS degree covers the light?18.75%vs.40%,P>0.05?,medium?43.75%vs.40%,P>0.05?,severe?37.5%vs.20%,P>0.05?.There was no significant difference in APACHE II score and number of organ failure between the two groups?all P>0.05?.Comparison of basic hemodynamics between the two groups:there were no statistically significant differences in heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,central venous pressure and noradrenaline dosage between the two groups at 12 hours of admission?all P>0.05?.2.Comparison of gas exchange indicators and PEEP between the two groups:there were no statistically significant differences in PH,PaO₂,PaO₂/FiO₂,PaCO₂,Lac and PEEP at the12-hour mechanical ventilation node between the two groups?all P>0.05?,but according to data analysis,it was found that the non-standard treatment group had significantly higher FiO₂Settings than the control group?P<0.05?.3.There were no statistically significant differences between the two groups in terms of length of stay in ICU,invasive ventilation days,and barotrauma?all P>0.05?.Conclusion:1.Although both groups were able to achieve the same target oxygenation when there was a higher oxygen concentration in the non-standard treatment group,the level of PEEP in the non-standard treatment group was relatively low,which increased the risk of shear injury during prolonged mechanical ventilation.2.During mechanical ventilation of ARDS patients in the department,the relevant Settings of PEEP and FiO₂ do not match and are not standardized,which leads to great potential risks.We need to follow the FiO₂-PEEP table recommended by ARDS treatment Cooperative group for further optimization and improvement.