Ultrassonography in PEEP Titration for Patients with ARDS: A narrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v12i13.44012

Keywords:

Positive pressure respiration; Acute respiratory distress syndrome; Ultrasound.

Abstract

This study aims to verify, through a narrative review, the importance of lung ultrasound in choosing the ideal Positive End-Expiratory Pressure (PEEP) in patients with Acute Respiratory Distress Syndrome (ARDS). Accurately determining the appropriate PEEP level is essential to optimize ARDS management, balancing lung recruitment and improving oxygenation without causing adverse effects. The article explores the role of lung ultrasound in dynamic visualization of lung structures, allowing real-time assessment of lung conditions. Furthermore, methods for determining PEEP and the correlation between lung ultrasound and computed tomography in the assessment of lung aeration are discussed. Based on the available evidence, this review suggests that lung ultrasound is an incipient tool to guide the choice of PEEP in patients with ARDS, contributing to a more personalized and effective approach to treating these patients. But due to few studies carried out to date multicenter and randomized studies, research must be carried out.

References

Abdelhameed, A. M. A., Alrifai, A. W. S., & Abdelhay, A. I. (2020). Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP. International Journal of Medical Arts. https://doi.org/10.21608/ijma.2020.116075

Algieri, I., Mongodi, S., Chiumello, D., Mojoli, F., Cressoni, M., Via, G., Luoni, S., Colombo, A., Babini, G., & Braschi, A. (2014). CT scan and ultrasound comparative assessment of PEEP-induced lung aeration changes in ARDS. Critical Care, 18(Suppl 1), P285. https://doi.org/10.1186/cc13475

Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4(1), 5. https://doi.org/10.1186/s41073-019-0064-8

Bhat, S., Johnson, D., Pierog, J., Zaia, B., Williams, S., & Gharahbaghian, L. (2015). Prehospital Evaluation of Effusion, Pneumothorax, & Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services. Western Journal of Emergency Medicine, 16(4), 503–509. https://doi.org/10.5811/westjem.2015.5.25414

Boesing, C., Graf, P. T., Schmitt, F., Thiel, M., Pelosi, P., Rocco, P. R. M., Luecke, T., & Krebs, J. (2022). Effects of different positive end-expiratory pressure titration strategies during prone positioning in patients with acute respiratory distress syndrome: a prospective interventional study. Critical Care, 26(1), 82. https://doi.org/10.1186/s13054-022-03956-8

Borges Migliavaca, C., Stein, C., Colpani, V., Barker, T. H., Munn, Z., & Falavigna, M. (2020). How are systematic reviews of prevalence conducted? A methodological study. BMC Medical Research Methodology, 20(1), 96. https://doi.org/10.1186/s12874-020-00975-3

Bosso, G., Sansone, G., Papillo, M., Giaquinto, A., Orefice, S., Allegorico, E., Serra, C., Minerva, V., Mercurio, V., Cannavacciuolo, F., Dello Vicario, F., Porta, G., Pagano, A., & Numis, F. G. (2023). Lung ultrasound-guided PEEP titration in COVID–19 patients treated with CPAP. Journal of Basic and Clinical Physiology and Pharmacology, 34(5), 677–682. https://doi.org/10.1515/jbcpp-2023-0165

Cho, R. J., Adams, A., Ambur, S., Lunos, S., Shapiro, R., & Prekker, M. E. (2020). Ultrasound Assessment of Diaphragmatic Motion in Subjects With ARDS During Transpulmonary Pressure-Guided PEEP Titration. Respiratory Care, 65(3), 314–319. https://doi.org/10.4187/respcare.06643

Cortes-Puentes, G. A., Gattinoni, L., & Marini, J. J. (2023). Physiology-Based Approach to PEEP Titration in COVID-19 ARDS. Respiratory Care, 68(2), 290–292. https://doi.org/10.4187/respcare.10811

Dunstan, E., Cook, J.-L., & Coyer, F. (2019). Safety culture in intensive care internationally and in Australia: A narrative review of the literature. Australian Critical Care, 32(6), 524–539. https://doi.org/10.1016/j.aucc.2018.11.003

ElHaffar, G., Durif, F., & Dubé, L. (2020). Towards closing the attitude-intention-behavior gap in green consumption: A narrative review of the literature and an overview of future research directions. Journal of Cleaner Production, 275, 122556. https://doi.org/10.1016/j.jclepro.2020.122556

Elshazly, M., Khair, T., Bassem, M., & Mansour, M. (2021). The use of intraoperative bedside lung ultrasound in optimizing positive end expiratory pressure in obese patients undergoing laparoscopic bariatric surgeries. Surgery for Obesity and Related Diseases, 17(2), 372–378. https://doi.org/10.1016/j.soard.2020.09.023

Haddaway, N. R., Bethel, A., Dicks, L. V., Koricheva, J., Macura, B., Petrokofsky, G., Pullin, A. S., Savilaakso, S., & Stewart, G. B. (2020). Eight problems with literature reviews and how to fix them. Nature Ecology & Evolution, 4(12), 1582–1589. https://doi.org/10.1038/s41559-020-01295-x

Heunks, L., Piquilloud, L., & Demoule, A. (2023). How we approach titrating PEEP in patients with acute hypoxemic failure. Critical Care, 27(1), 415. https://doi.org/10.1186/s13054-023-04694-1

Kim, K. T., Morton, S., Howe, S., Chiew, Y. S., Knopp, J. L., Docherty, P., Pretty, C., Desaive, T., Benyo, B., Szlavecz, A., Moeller, K., Shaw, G. M., & Chase, J. G. (2020). Model-based PEEP titration versus standard practice in mechanical ventilation: a randomised controlled trial. Trials, 21(1), 130. https://doi.org/10.1186/s13063-019-4035-7

Sahetya, S. K., Hager, D. N., Stephens, R. S., Needham, D. M., & Brower, R. G. (2020). PEEP Titration to Minimize Driving Pressure in Subjects With ARDS: A Prospective Physiological Study. Respiratory Care, 65(5), 583–589. https://doi.org/10.4187/respcare.07102

Salem, M. S., Eltatawy, H. S., Abdelhafez, A. A., & Alsherif, S. E. I. (2020). Lung ultrasound- versus FiO 2 -guided PEEP in ARDS patients. Egyptian Journal of Anaesthesia, 36(1), 31–37. https://doi.org/10.1080/11101849.2020.1741253

Siddaway, A. P., Wood, A. M., & Hedges, L. V. (2019). How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses. Annual Review of Psychology, 70(1), 747–770. https://doi.org/10.1146/annurev-psych-010418-102803

Somhorst, P., van der Zee, P., Endeman, H., & Gommers, D. (2022). PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS. Critical Care, 26(1), 272. https://doi.org/10.1186/s13054-022-04135-5

Theerawit, P., Pukapong, P., & Sutherasan, Y. (2023). Relationship between lung ultrasound and electrical impedance tomography as regional assessment tools during PEEP titration in acute respiratory distress syndrome caused by multi-lobar pneumonia: a pilot study. Journal of Clinical Monitoring and Computing, 37(3), 889–897. https://doi.org/10.1007/s10877-022-00962-7

Tonelotto, B., Pereira, S. M., Tucci, M. R., Vaz, D. F., Vieira, J. E., Malbouisson, L. M., Gay, F., Simões, C. M., Carvalho Carmona, M. J., Monsel, A., Amato, M. B., Rouby, J.-J., & Costa Auler, J. O. (2020). Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study. Anaesthesia Critical Care & Pain Medicine, 39(6), 825–831. https://doi.org/10.1016/j.accpm.2020.09.009

Yu, M., Deng, Y., Cha, J., Jiang, L., Wang, M., Qiao, S., & Wang, C. (2023). PEEP titration by EIT strategies for patients with ARDS: A systematic review and meta-analysis. Medicina Intensiva (English Edition), 47(7), 383–390. https://doi.org/10.1016/j.medine.2022.06.020

Yuan, X., Zhang, R., Wang, Y., Chen, D., Chao, Y., Xu, J., Guo, L., Liu, A., Xie, J., Pan, C., Yang, Y., Qiu, H., & Liu, L. (2023). Effect of EIT-guided PEEP titration on prognosis of patients with moderate to severe ARDS: study protocol for a multicenter randomized controlled trial. Trials, 24(1), 266. https://doi.org/10.1186/s13063-023-07280-6

Zimatore, C., Algera, A. G., Botta, M., Pierrakos, C., Serpa Neto, A., Grasso, S., Schultz, M. J., Pisani, L., & Paulus, F. (2023). Lung Ultrasound to Determine the Effect of Lower vs. Higher PEEP on Lung Aeration in Patients without ARDS—A Substudy of a Randomized Clinical Trial. Diagnostics, 13(12), 1989. https://doi.org/10.3390/diagnostics13121989)

Published

25/11/2023

How to Cite

BARROS, G. M. de .; LIMA FILHO, J. F. . Ultrassonography in PEEP Titration for Patients with ARDS: A narrative review. Research, Society and Development, [S. l.], v. 12, n. 13, p. e16121344012, 2023. DOI: 10.33448/rsd-v12i13.44012. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/44012. Acesso em: 8 oct. 2024.

Issue

Section

Review Article