Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study

We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18-years-old, severe COVID-19-related ARDS, driving pressure ΔP >15 cmH2O despite low-VT strategy, and extracorporeal therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%-75%). Mixed effects analysis and Dunnett s test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170-192) to 152 (137-170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31-40) to 29 (26-34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds. © 2024 Turkish Journal of Emergency Medicine.

Notas

Indexación: Scopus

Palabras clave

Acute respiratory distress syndrome, COVID-19, hypoxemia, lung protective ventilation, mild hypothermia

Citación

Turkish Journal of Emergency Medicine Volume 24, Issue 2, Pages 117-121 2024

DOI

10.4103/tjem.tjem_339_22

URI

https://repositorio.unab.cl/handle/ria/61398

Colecciones

Fac.CV - Artículos de Revista

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