The following is a summary of “Impact of extended lung protection during mechanical ventilation on lung recovery in patients with COVID-19 ARDS: a phase II randomized controlled trial,” published in the June 2024 issue of Critical Care by Costa et al.
While protective ventilation is essential for early Acute Respiratory Distress Syndrome (ARDS), the ideal duration and the impact of high driving pressures (ΔP) on lung recovery remain unclear.
Researchers conducted a retrospective study to evaluate the feasibility and impact on lung recovery of an extended lung protection strategy with a protocol to manage patient ventilatory drive in patients with ARDS.
They involved patients with moderate/severe COVID-19-ARDS, characterized by low respiratory system compliance (CRS < 0.6 (mL/Kg)/cmH2O). The intervention involved a ventilation strategy guided by Electrical Impedance Tomography to minimize ΔP and patient ventilatory drive. Meanwhile, the control group followed the ARDSNet low-PEEP strategy. The primary focus was on the modified lung injury score (mLIS), which combined daily measurements of CRS, oxygen requirements, oxygenation, and X-rays up to day 28. The mLIS score was also adjusted hierarchically for survival and extubation rates.
The results showed prematurely due to 3 consecutive months without patient enrollment, attributed to the pandemic’s decline. The intention-to-treat analysis encompassed 76 patients, with 37 assigned to the intervention group. The average mLIS score over 28 days did not differ between groups (P=0.95, primary outcome). However, the intervention group demonstrated quicker mLIS improvement (1.4 vs. 7.2 days to achieve 63% of maximum improvement; P<0.001), driven by enhanced oxygenation and sustained X-ray improvement (P=0.001). The group also experienced a prolonged increase in CRS up to day 28 (P=0.009) and a shorter time from randomization to room-air breathing (P=0.02). Survival at 28 days and time until liberation from the ventilator were similar across both groups.
Investigators found that combining individualized PEEP with extended lung protection was feasible and showed promise for faster lung recovery, warranting a larger trial.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01297-z