High PEEP/low FiO2 ventilation is associated with lower mortality in COVID-19

Robin L Goossen; Relin van Vliet; Lieuwe D J Bos; Laura A Buiteman-Kruizinga; Markus W Hollman; Sheila N Myatra; Ary Serpa Neto; Peter E Spronk; Meta C E van der Woude; David M P van Meenen; Frederique Paulus; Marcus J Schultz; PRoVAcT-COVID investigators

doi:10.1016/j.jcrc.2024.154854

High PEEP/low FiO₂ ventilation is associated with lower mortality in COVID-19

J Crit Care. 2024 Oct:83:154854. doi: 10.1016/j.jcrc.2024.154854. Epub 2024 Jul 11.

Collaborators

PRoVAcT-COVID investigators:
S Ahuja, J P van Akkeren, A G Algera, C K Algoe, R B van Amstel, A Artigas, E Aydeniz, M Bailey, A E van den Berg, P van de Berg, D C J J Bergmans, D I van den Bersselaar, F A Bertens, M Bevers, A J G H Bindels, J S Breel, S de Bruin, C L Bruna, M de Boer, D P Boer, S den Boer, L S Boers, M B Bogerd, L D Bos, B Bosman, M Botta, A J R de Bie, O L Baur, L A Buiteman-Kruizinga, W Coene, O L Cremer, K Daenen, M Delmte, R M Determann, W Dieperink, V Di Leo, J van Dijk, D A Dongelmans, T Dormans, H Endeman, L M Elting, A A Esmeijer, D Filippini, J M Flim, H S Franke, M S Galek-Aldridge, M G Gama de Abreu, A R Girbes, D M Go, R L Goossen, M J de Graaff, L A Hagens, H J Hansen, J J Haringman, S T van der Heide, P L J van der Heiden, N F L Heijnen, S J P Hiel, L L Hoeijmakers, L Hol, M W Hollmann, M E Hoogendoorn, J Horn, I van der Horst, R van der Horst, J A Huijben, E L K Ie, L E van Ingen, D P Ivanov, N P Juffermans, H T Kranen, E Kho, E S de Klerk, N Koek, A W M M Koopman-van Gemert, M Koopmans, S Kucukcelebi, M A Kuiper, L J Kuipers, E Koornstra, A Lokhorst, D W de Lange, I Martin-Loeches, D M P van Meenen, G Mazzinari, H Moeniralam, N van Mourik, S N Myatra, S G Nijbroek, P van Oosten, M Offermans, M Onrust, E A N Oostdijk, F Paulus, C J Pennartz, J Peršec, V J T Peters, J J Pillay, L Pisani, T Pisters, A Prins, I M Purmer, T C D Rettig, A S Rezaee, O Roca, J Roozeman, J Rozendaal, N M Rosenberg, R Schavemaker, A Sciascera, M T U Schuijt, M J Schultz, A S Serpa Neto, G S Shrestha, B van Silfhout, M Sjoding, M E Sleeswijk, K M van Smaalen, M R Smit, P E Spronk, A Šribar, A C Strang, W Stilma, P Swart, P R Tuinman, A M Tsonas, C A den Uil, C M A Valk, F L Veen-Schra, A P J Vlaar, L I Veldhuis, W H van der Ven, F L I M van der Ven, P van Velzen, M Verboom, E J Verhoef, T D Vermeulen, P van Vliet, R van Vliet, J S Voorham, P H J van der Voort, L van Welie, D Weller, A R Wentink, H J F T Wesselink, H van der Wier-Lubbers, B van Wijk, H van Willigen, M C E van der Woude, J J Weiner, T Winters, W Y Wong, N Yaali, J M Zandvliet, A R H van Zanten, T Z I van Zijl, S A Zonneveld

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands. Electronic address: r.l.goossen@amsterdamumc.nl.
² Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
³ Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands.
⁴ Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
⁵ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
⁶ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁷ Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands.
⁸ Department of Intensive Care, Heerlen Medical Center, Heerlen, the Netherlands.
⁹ Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
¹⁰ Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Faculty of Health, ACHIEVE, center of applied research, University of Applied Research, Amsterdam, the Netherlands.
¹¹ Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria.

PMID: 38996499
DOI: 10.1016/j.jcrc.2024.154854

Abstract

Rationale: The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO₂ ventilation on outcomes during the second wave in the Netherlands.

Methods: Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality.

Results: This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings.

Conclusions: High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.

Keywords: Artificial; Intensive care; Pneumonia; Respiration; Respiratory distress syndrome; Respiratory insufficiency; Viral.

Publication types

Observational Study

MeSH terms

Aged
COVID-19* / mortality
COVID-19* / therapy
Female
Hospital Mortality*
Humans
Intensive Care Units
Length of Stay / statistics & numerical data
Male
Middle Aged
Netherlands / epidemiology
Positive-Pressure Respiration* / methods
Respiration, Artificial / methods
Respiration, Artificial / statistics & numerical data
Respiratory Distress Syndrome* / mortality
Respiratory Distress Syndrome* / therapy
Retrospective Studies
SARS-CoV-2