TY - JOUR T1 - Oxygenation or Driving Pressure for Setting PEEP in Obese Patients With COVID-19 ARDS JF - Respiratory Care SP - 260 LP - 264 DO - 10.4187/respcare.10127 VL - 68 IS - 2 AU - Javier H Dorado AU - Joaquín Pérez AU - Matías Accoce AU - Emiliano Navarro AU - Daniela I Gilgado AU - Gimena P Cardoso AU - Irene Telias AU - Laurent J Brochard Y1 - 2023/02/01 UR - http://rc.rcjournal.com/content/68/2/260.abstract N2 - Obese patients with COVID-19 are at greater risk of requiring mechanical ventilation and developing ARDS.1 Obesity is characterized by an increased pleural pressure due to higher thoraco-abdominal loading, which reduces end-expiratory lung volume, and causes atelectasis and airway compression.2 Consequently, it is usually recommended to use high PEEP to improve gas exchange and avoid atelectrauma.2 However, inadequately high PEEP may cause overdistention and lung injury together with increased dead space, reduced cardiac output, and ultimately decreased oxygen delivery.3 Whereas clinicians often target oxygenation for PEEP titration, identifying more relevant bedside tools to guide PEEP selection may help to decide whether high PEEP might be deleterious. We assessed whether selecting subjects based on response in airway driving pressure (ΔP) when setting high PEEP would indicate potential physiological benefits that would otherwise not be recognized by the oxygenation response. The study was performed in a relatively homogeneous population of obese subjects with COVID-19 ARDS.We conducted a physiological study including consecutive, sedated, and curarized obese (body mass index [BMI] > 30 kg/m2) subjects with moderate-severe COVID-19 ARDS ventilated in volume control with tidal volume (VT) of 6 mL/kg of predicted body weight to keep plateau pressure (Pplat) < 30 cm H2O and ΔP < 15 cm H2O, with 0.3 s of end-inspiratory pause and breathing frequency to achieve pH 7.20–7.45. We evaluated the respiratory system mechanics using a specific device (FluxMed, MBMed, Buenos Aires, Argentina). We inserted an esophageal balloon catheter (VA-A-008, MBMed) filled with 0.5 mL of air that correct position was confirmed accordingly.4 Expired CO2 was measured with a monitor previously validated (FluxMed, MBMed) that combines a mainstream Capnostat (Capnostat 5, Philips, Amsterdam, the Netherlands) and a specific software. After a stepwise recruitment maneuver (maximum airway pressure … Correspondence: Laurent Brochard MD, Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St Michael’s Hospital, Toronto, Ontario, Canada. E-mail: Laurent.Brochard{at}unityhealth.to ER -