Banca de DEFESA: ROMULO DE AQUINO COELHO LINS

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : ROMULO DE AQUINO COELHO LINS
DATE: 31/08/2022
TIME: 13:00
LOCAL: Departamento de Fisioterapia
TITLE:

Respiratory and hemodynamic repercussions of different PEEP titration strategies in patients with moderate ARDS by Covid-19: an exploratory analysis.

KEY WORDS:

SARS-CoV-2 Infections, Respiratory Distress Syndrome, Positive End Expiratory Pressure, Patient Monitoring.

PAGES: 80
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Background:Severe cases of COVID-19 can develop severe acute respiratory syndrome (ARDS), characterized by severe hypoxemia and respiratory failure, requiring orotracheal intubation and mechanical ventilatory support. Positive end-expiratory pressure (PEEP), one of the parameters of the protective ventilatory strategy, must be individualized in order to optimize oxygenation, reduce lung injuries and deleterious outcomes. Among the different methods of PEEP titration for patients with respiratory failure, there is still no consensus on the ideal method of PEEP titration for patients with Covid-19.

Objective:To describe the acute response over four hours post-titration of PEEP by PEEP table vs. Driving pressure guided PEEP on oxygenation and gas exchange, respiratory mechanics and hemodynamics.

Methods:Exploratory analysis of the NTC U1111-1255-6129 study, in which oxygenation and gas exchange (ratio between PaO2/FiO2, peripheral oxygen saturation - Peripheral oxygen saturation - SpO2), respiratory mechanics (Peak pressure, Plateau pressure, driving pressure (DP), (Static compliance - Cest, Airway resistance - Rva) and hemodynamics (Heart rate - HR, Mean arterial pressure - MAP) of patients with moderate ARDS by Covid-19, submitted to titration by PEEP table and Driving Pressure guide-PEEP were monitored after 0.5, 1, 2 and 4 hours.

Results:In the sample stratum of 27 patients, for most baseline clinical characteristics at admission there were no differences between groups, except for PaO2/FiO2 (PEEP table, median 128.7 [IQ 117-175] vs. guided-PEEP DP, median 140.0 [ IQ 138-178}, p=0.005). In the linear model, corrected for baseline PaO2/FiO2, there were differences only for SpO2 in the group x moment interaction (p=0.004). PEEP 10 cmH2O was titrated in 93.3% of cases in the PEEP table group and in 91.7% of cases titrated by DP guided PEEP (p = 0.167).

Conclusions:The titrated PEEP in the Covid-19-moderate ARDS sample had a frequent value of 10 cmH2O in the PEEP table and DP guided PEEP groups, also generating similar clinical responses after 4 hours of titration for oxygenation, gas exchange and respiratory mechanics.

BANKING MEMBERS:
Presidente - 2581397 - DANIELLA CUNHA BRANDAO
Externo à Instituição - ANTÔNIO CHRISTIAN EVANGELISTA GONÇALVES
Externa à Instituição - MARIA DA GLORIA RODRIGUES MACHADO