Transpulmonary pressures in obese and non-obese COVID-19 ARDS

• Main Authors: Mehdi Mezidi, Florence Daviet, Paul Chabert, Sami Hraiech, Laurent Bitker, Jean-Marie Forel, Hodane Yonis, Ines Gragueb, Francois Dhelft, Laurent Papazian, Jean-Christophe Richard, Christophe Guervilly
• Format: Article
• Language: English
• Published: SpringerOpen 2020-10-01
• Series: Annals of Intensive Care
• Online Access: http://link.springer.com/article/10.1186/s13613-020-00745-w

Abstract Background Data on respiratory mechanics of COVID-19 ARDS patients are scarce. Respiratory mechanics and response to positive expiratory pressure (PEEP) may be different in obese and non-obese patients. Methods We investigated esophageal pressure allowing determination of transpulmonary pressures (PL ) and elastances (EL) during a decremental PEEP trial from 20 to 6 cm H2O in a cohort of COVID-19 ARDS patients. Results Fifteen patients were investigated, 8 obese and 7 non-obese patients. PEEP ≥ 16 cm H2O for obese patients and PEEP ≥10 cm H2O for non-obese patients were necessary to obtain positive expiratory P L . Change of PEEP did not alter significantly ΔP L or elastances in obese patients. However, in non-obese patients lung EL  and ΔP L increased significantly with PEEP increase. Chest wall EL was not affected by PEEP variations in both groups.