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Am J Emerg Med
. 2025 Mar 27:93:73-79.
doi: 10.1016/j.ajem.2025.03.050. Online ahead of print. Evaluation of limiting PEEP effectiveness in preventing barotrauma in critically ill COVID-19 patients: A retrospective study
Yuhei Irie 1 , Yoshito Izutani 2 , Junta Noake 2 , Shun Ninomiya 2 , Mami Kastumura 2 , Maiko Nakashio 2 , Junichi Maruyama 2 , Yoshihiko Nakamura 2 , Hiroyasu Ishikura 3
Affiliations
Background: Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO2) in patients with COVID-19 undergoing invasive mechanical ventilation.
Materials and methods: We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO2 table) and a limited PEEP group (maximum PEEP of <10 cmH2O) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.
Results: Patients in the ordinary PEEP group (n = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (n = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.
Conclusions: Limiting the maximum PEEP to <10 cmH2O may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.
Keywords: Acute respiratory distress syndrome; Barotrauma; Coronavirus disease 2019; Mechanical ventilation; Positive end-expiratory pressure; Severe acute respiratory syndrome coronavirus 2.
. 2025 Mar 27:93:73-79.
doi: 10.1016/j.ajem.2025.03.050. Online ahead of print. Evaluation of limiting PEEP effectiveness in preventing barotrauma in critically ill COVID-19 patients: A retrospective study
Yuhei Irie 1 , Yoshito Izutani 2 , Junta Noake 2 , Shun Ninomiya 2 , Mami Kastumura 2 , Maiko Nakashio 2 , Junichi Maruyama 2 , Yoshihiko Nakamura 2 , Hiroyasu Ishikura 3
Affiliations
- PMID: 40174464
- DOI: 10.1016/j.ajem.2025.03.050
Background: Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO2) in patients with COVID-19 undergoing invasive mechanical ventilation.
Materials and methods: We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO2 table) and a limited PEEP group (maximum PEEP of <10 cmH2O) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.
Results: Patients in the ordinary PEEP group (n = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (n = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.
Conclusions: Limiting the maximum PEEP to <10 cmH2O may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.
Keywords: Acute respiratory distress syndrome; Barotrauma; Coronavirus disease 2019; Mechanical ventilation; Positive end-expiratory pressure; Severe acute respiratory syndrome coronavirus 2.