Comparing the Benefits of Titrated PEEP vs Low PEEP in Terms of Mortality in Patients Suffering from Acute Respiratory Distress Syndrome

Abstract

Objective:  To compare the benefits of titrated PEEP vs low PEEP in terms of mortality in patients suffering from acute respiratory distress syndrome

Study Design: Randomized clinical trial

Place and Duration of Study: Intensive care unit (ICU) of Nishtar Hospital Multan over a period of January 2017 to January 2018.

Methodology:  Patients were randomly divided into two groups LP group and TP group. TP group received fluids and neuromuscular blockers. Lung recruitment maneuver was done with incremental PEEP level and in the second time by a decremental PEEP maneuver. If levels of PaO₂ and FIO₂ were same or increasing during one day we stared to decrease the PEEP of 2cm Hg for every 8 hours. .

Results: Of the outcome variables, numbers of death within 28 days were significantly higher in the low PEEP group (p-value 0.045 and 0.022, respectively). Development of pneumothorax requiring drainage and incidence of barotrauma within the first 7 days was significantly less in the titrated PEEP group. During the first 28 days, more number of patients in the titrated PEEP group had ventilator free days.

Conclusion: In our study we find that the deaths within 28 days, development of pneumothorax requiring drainage and incidence of barotrauma within the first 7 days were significantly higher in the low PEEP group.