AI Article Synopsis
- The study investigates the effects of helmet CPAP on oxygenation levels in hypoxemic patients, analyzing improvements linked to PEEP or oxygen fraction.
- A test called the "ZEEP-PEEP test" was developed to determine whether improvements in oxygenation after helmet application were due to PEEP or better oxygen delivery.
- Results showed significant oxygenation improvements in patients after applying helmet CPAP, with 41% of patients responding positively to PEEP, while the ZEEP-PEEP test could help identify those who would benefit from PEEP use.
Article Abstract
Introduction: The improvement in oxygenation after helmet application in hypoxemic patients may be explained by the alveolar recruitment obtained with positive end expiratory pressure (PEEP) or by the administration of a more accurate inspiratory fraction of oxygen (FO). We have designed the "ZEEP-PEEP test", capable to distinguish between the FO-related or PEEP-related oxygenation improvement. Our primary aim was to describe the use of this test during helmet CPAP to assess the oxygenation improvement attributable to PEEP application.
Material And Methods: We performed a prospective physiological study including adult critically ill patients. Respiratory and hemodynamic parameters were recorded before helmet application (PRE step), after helmet application without PEEP (ZEEP step) and after the application of the PEEP valve (PEEP step), while maintaining a constant FiO. We defined as "PEEP responders" patients showing a PaO/FiO ratio improvement ≥10% after PEEP application.
Results: 93 patients were enrolled. Compared to the PRE step, PaO2/FiO2 ratio was significantly improved during helmet CPAP both at ZEEP and PEEP step (189 ± 55, 219 ± 74 and 241 ± 82 mmHg, respectively, p < 0.01). Both PEEP responders (41%) and non-responders showed a significant improvement of PaO2/FiO2 ratio after the application of helmet at ZEEP, PEEP responders also showed a significant improvement of oxygenation after PEEP application (208 ± 70 vs 267 ± 85, p < 0.01).
Conclusions: Helmet CPAP improved oxygenation. This improvement was not only due to the PEEP effect, but also to the increase of the effective inspired FiO. Performing the ZEEP-PEEP test may help to identify patients who benefit from PEEP.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957420 | PMC |
| http://dx.doi.org/10.1016/j.heliyon.2024.e28339 | DOI Listing |
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