Journal of critical care
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Journal of critical care · Feb 2025
LetterElectrical impedance tomography to set high pressure in time-controlled adaptive ventilation.
TCAV (Time controlled adaptive ventilation), a combination of settings applied to the APRV (airway pressure release ventilation) mode, provides personalized ventilation tailored to the lung condition in ARDS (acute respiratory distress syndrome). The objective was to evaluate whether electrical impedance tomography (EIT) could serve as a tool for guiding Phigh level in TCAV for ARDS patients. ⋯ EIT enabled detection of regional ventilation distribution on TCAV during a decremental Phigh trial and thus enabled the determination of a best EIT-derived-Phigh through an individualized approach, achieving best compromise between overdistension and collapse. The observed overdistention variability highlights the necessity of Phigh level personalization on TCAV.
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Journal of critical care · Feb 2025
Multicenter Study Comparative Study Observational StudyA tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients.
The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH2O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH2O. ⋯ A tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH2O. This finding should be interpreted cautiously due to the retrospective study design.