{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:37:56Z","timestamp":1768916276899,"version":"3.49.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The profile of changes in airway driving pressure (dP<jats:sub>aw<\/jats:sub>) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dP<jats:sub>aw<\/jats:sub> versus PEEP curves behavior in ARDS from COVID-19 patients.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients admitted in three hospitals were ventilated with fraction of inspired\u00a0oxygen (FiO<jats:sub>2<\/jats:sub>) and PEEP initially adjusted by oxygenation-based table. Thereafter, PEEP was reduced from 20 until 6 cmH<jats:sub>2<\/jats:sub>O while dP<jats:sub>aw<\/jats:sub> was stepwise recorded and the lowest PEEP that minimized dP<jats:sub>aw<\/jats:sub> (PEEPmin_dP<jats:sub>aw<\/jats:sub>) was assessed. Each dP<jats:sub>aw<\/jats:sub> vs PEEP curve was classified as J-shaped, inverted-J-shaped, or U-shaped according to the difference between the minimum dP<jats:sub>aw<\/jats:sub> and the dP<jats:sub>aw<\/jats:sub> at the lowest and highest PEEP. In one hospital, hyperdistention and collapse at each PEEP were assessed by electrical impedance tomography (EIT).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>184 patients (41 including EIT) were studied. 126 patients (68%) exhibited a J-shaped dP<jats:sub>aw<\/jats:sub> vs PEEP profile (PEEPmin_dP<jats:sub>aw<\/jats:sub> of 7.5\u2009\u00b1\u20091.9 cmH<jats:sub>2<\/jats:sub>O). 40 patients (22%) presented a U (PEEPmin_dP<jats:sub>aw<\/jats:sub> of 12.2\u2009\u00b1\u20092.6 cmH<jats:sub>2<\/jats:sub>O) and 18 (10%) an inverted-J profile (PEEPmin_dP<jats:sub>aw<\/jats:sub> of 14,6\u2009\u00b1\u20092.3 cmH<jats:sub>2<\/jats:sub>O). Patients with inverted-J profiles had significant higher body mass index (BMI) and lower baseline partial pressure of arterial oxygen\/FiO<jats:sub>2<\/jats:sub> ratio. PEEPmin_dP<jats:sub>aw<\/jats:sub> was associated with lower fractions of both alveolar collapse and hyperinflation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>A PEEP adjustment procedure based on PEEP-induced changes in dP<jats:sub>aw<\/jats:sub> is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13054-023-04345-5","type":"journal-article","created":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T21:09:32Z","timestamp":1679864972000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19\u00a0Acute Respiratory Distress Syndrome patients"],"prefix":"10.1186","volume":"27","author":[{"given":"M\u00f4nica Rodrigues","family":"da Cruz","sequence":"first","affiliation":[]},{"given":"Luciana Mois\u00e9s","family":"Camilo","sequence":"additional","affiliation":[]},{"given":"Tiago Batista","family":"da Costa Xavier","sequence":"additional","affiliation":[]},{"given":"Gabriel Casulari","family":"da Motta Ribeiro","sequence":"additional","affiliation":[]},{"given":"Denise Machado","family":"Medeiros","sequence":"additional","affiliation":[]},{"given":"Lu\u00eds Felipe","family":"da Fonseca Reis","sequence":"additional","affiliation":[]},{"given":"Bruno Leonardo","family":"da Silva Guimar\u00e3es","sequence":"additional","affiliation":[]},{"given":"Andr\u00e9 Miguel","family":"Japiass\u00fa","sequence":"additional","affiliation":[]},{"given":"Alysson Roncally Silva","family":"Carvalho","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"key":"4345_CR1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5669","author":"GD Rubenfeld","year":"2012","unstructured":"Rubenfeld GD, Thompson T, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. 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