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The following is a summary of “High PEEP/low FiO₂ ventilation is associated with lower mortality in COVID–19,” published in the October 2024 issue of Critical Care by Goossen et al. 

The effectiveness of positive end-expiratory pressure (PEEP) therapy for patients with COVID-19 acute respiratory distress syndrome (ARDS) was uncertain based on early pandemic studies.  

Researchers conducted a retrospective study to evaluate the patient outcomes with effect of high PEEP/low FiO₂ ventilation during the second wave of COVID-19 in the Netherlands.  

They examined patients who were COVID-19 ventilated during the second wave. Patients were categorized based on high PEEP (ARDS Network tables) or low PEEP ventilation. ICU mortality was the primary outcome, and secondary outcomes included hospital and 90-day mortality, ventilation and stay duration, and kidney injury occurrence. Propensity matching was performed to adjust for factors related to ICU mortality.  

The results showed that 790 patients with COVID-ARDS were included. At ICU discharge, 22.5% (32/142) were patients of high PEEP and 39.2% (254/848) patients died of low PEEP (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP improved secondary outcomes, and analysis were matched. 

Investigators concluded that high PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS. 

Source: sciencedirect.com/science/article/pii/S0883944124003411