Research published in Crit_Care reports that driving pressure-guided ventilation strategy significantly reduces the mechanical power compared to predicted body weight-guided ventilation in the Acute Respiratory Distress Syndrome.
Data were analyzed using SPSS Base 20.0 statistical software package . Sample size calculation was made using the “pwr” package in R . To be able to show a potential difference in mechanical power between-Vent and ΔP-Vent with a medium effect size—the effect size being the difference between the means divided by the pooled standard deviation; a value of 0.5 defining a medium effect size for paired comparisons []—a type I error of 0.
. The basal ΔP during PBW-Vent was already within the target range of ΔP-Vent in five patients , above in nine and below in 36 . Thus, thewas left unchanged in five patients, decreased in nine and increased in 36. In all patients in whom tidal volume was increased, the increase was possible to meet the target ΔP before the plateau pressure limit was reached.
Table 1 Characteristics of patients who underwent predicted body weight- and driving pressure-guided ventilationCompared to PBW-Vent, ΔP-Vent was accompanied by a significant decrease in mechanical power from 31.5 J/min [28–35.7] to 28.8 J/min [24.6–32.6] (
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Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study - Critical CareBackground Awake prone positioning (APP) reduces the intubation rate in COVID-19 patients treated by high-flow nasal cannula (HFNC). However, the lung aeration response to APP has not been addressed. We aimed to explore the lung aeration response to APP by lung ultrasound (LUS). Methods This two-center, prospective, observational study enrolled patients with COVID-19-induced acute hypoxemic respiratory failure treated by HFNC and APP. LUS score was recorded 5–10 min before, 1 h after APP, and 5–10 min after supine in the first APP session within the first three days. The primary outcome was LUS score changes in the first three days. Secondary outcomes included changes in SpO2/FiO2 ratio, respiratory rate and ROX index (SpO2/FiO2/respiratory rate) related to APP, and the rate of treatment success (patients who avoided intubation). Results Seventy-one patients were enrolled. LUS score decreased from 20 (interquartile range [IQR] 19–24) to 19 (18–21) (p 1 after the first APP session was associated with decreased risk for intubation (Relative risk 0.25 [0.09–0.69]). APP daily duration was correlated with LUS score reduction in patients with treatment success, especially in dorsal lung zones (r = − 0.76; p | 0.001). Conclusions In patients with acute hypoxemic respiratory failure due to COVID-19 and treated by HFNC, APP reduced LUS score. The reduction in dorsal LUS scores after APP was associated with treatment success. The longer duration on APP was correlated with greater lung aeration. Trial registration This study was prospectively registered on clinicaltrials.gov on April 22, 2021. Identification number NCT04855162 .
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