Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.

Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Ramírez, Yenny; Díaz, Franco

Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.

dc.contributor.author	Cruces, Pablo
dc.contributor.author	Moreno, Diego
dc.contributor.author	Reveco, Sonia
dc.contributor.author	Ramírez, Yenny
dc.contributor.author	Díaz, Franco
dc.date.accessioned	2024-07-30T12:55:01Z
dc.date.available	2024-07-30T12:55:01Z
dc.date.issued	2024-04
dc.description.abstract	We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18 years old, severe COVID 19 related ARDS, driving pressure ∆P >15 cmH2 O despite low-VT strategy, and extracorporea therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%–75%). Mixed effects analysis and Dunnett’s test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170–192) to 152 (137–170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31–40) to 29 (26–34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2 O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.
dc.identifier.citation	Turkish Journal of Emergency Medicine, Vol. 24, N°2, (2024) p. 117-121.
dc.identifier.doi	10.4103/tjem.tjem_339_22
dc.identifier.issn	2452-2473
dc.identifier.orcid	http://orcid.org/0000-0003-4763-074X
dc.identifier.uri	http://hdl.handle.net/20.500.12254/3788
dc.language.iso	en
dc.publisher	The Emergency Medicine Association of Turkey
dc.rights	Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.uri	http://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subject	COVID-19
dc.subject	Hypoxemia
dc.subject	Mild hypothermia
dc.subject	Lung protective ventilation
dc.subject	Acute respiratory distress syndrome
dc.title	Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.
dc.type	Article