• Journal of critical care · Oct 2024

    Observational Study

    High PEEP/low FiO2 ventilation is associated with lower mortality in COVID-19.

    • Robin L Goossen, Relin van Vliet, BosLieuwe D JLDJDepartment of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Laura A Buiteman-Kruizinga, Markus W Hollman, Sheila N Myatra, NetoAry SerpaASAustralian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Depa, Peter E Spronk, Meta C E van der Woude, van MeenenDavid M PDMPDepartment of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands., Frederique Paulus, Marcus J Schultz, and PRoVAcT-COVID investigators.
    • Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands. Electronic address: r.l.goossen@amsterdamumc.nl.
    • J Crit Care. 2024 Oct 1; 83: 154854154854.

    RationaleThe positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO2 ventilation on outcomes during the second wave in the Netherlands.MethodsRetrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality.ResultsThis analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings.ConclusionsHigh PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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