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    Effects of end-expiratory lung volume versus PaO2 guided PEEP determination on respiratory mechanics and oxygenation in moderate to severe ARDS
    (Taylor & Francis Inc, 2022) Rollas, Kazim; Hanci, Pervin; Topeli, Arzu
    Background: There is no ideal method for determination of positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) patients. We compared the effects of end-expiratory lung volume (EELV)-guided versus PaO2-guided PEEP determination on respiratory mechanics and oxygenation during the first 48 hours in moderate to severe ARDS. Methods: Twenty-two patients with moderate to severe ARDS admitted to an academic medical ICU were assigned to PaO2-guided (n = 11) or to EELV-guided PEEP determination (n = 11) group. First, an incremental PEEP trial was performed by increasing PEEP by 3 cmH(2)O steps from 8 to 20 cmH(2)O and in each step EELV and lung mechanics were measured in both groups. Then, oxygenation and respiratory mechanics were measured under the determined PEEP at 4, 12, 24, and 48th hours. Results: After the incremental PEEP trial, over the 48 hours of the study period, in the EELV-guided group PaO2 and PaO2/FiO(2) increased (p = 0.04 and p = 0.02; respectively), whereas they did not change in PaO2-guided group (p = 0.09 and p = 0.27; respectively). In all patients, the median value of EELV change (Delta EELV) during incremental PEEP trial was 25%. In patients with Delta EELV > 25% (n = 11) PaO2, PaO2/FiO(2) and Cs increased over time in 48 hours (p = 0.03, p < 0.01, and p = 0.04; respectively), whereas they did not change in those with Delta EELV <= 25% (n = 11) (p = 0.73, p = 0.51, and p = 0.73; respectively). Conclusion: Compared to PaO2-guided PEEP determination, EELV-guided PEEP determination resulted in greater improvement in oxygenation over time. Patients who had > 25% improvement in EELV during a PEEP trial had greater improvement in oxygenation and compliance over 48 hours. Supplemental data for this article is available online at
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    The Use of High-Flow Nasal Oxygen Therapy in the Management of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study
    (Aves, 2022) Hanci, Pervin; Ocal, Serpil; Kaya, Esat Kivanc; Topeli, Arzu
    OBJECTIVE: This study investigated the efficacy of high-flow nasal oxygen therapy in patients with severe acute exacerbation of chronic obstructive pulmonary disease admitted to the intensive care unit. MATERIAL AND METHODS: Totally, 23 patients were enrolled in the study. High-flow nasal oxygen therapy was administered with a predefined protocol. Vital signs, Visual Analog Scale for dyspnea, and arterial blood gas parameters were recorded at the beginning under low-flow oxygen support therapy and the 1st, 6th, 12th, and 24th hours of high-flow nasal oxygen therapy. High-flow nasal oxygen therapy duration, intensive care unit length of stay, and intensive care unit, in-hospital, and 60-day mortality were recorded as outcomes and compared according to the presence of pneumonia upon admission. RESULTS: In 12 patients (52.2%), pneumonia was present. High-flow nasal oxygen therapy was applied for a median of 57 hours [49.2-104.5]. Overall decreases were detected in heart rate (P=.001), respiratory rate (P<.001), and Visual Analog Scale for dyspnea (P=.001) during the first 24 hours of the therapy. Although there was an increase in PaCO2 (P=.001), pH increased (P<.001) over time too. No change in partial arterial oxygen pressure (P=.63) and partial arterial oxygen pressure/fraction of inspired oxygen ratio (P=.22) was noted. Nineteen patients (77%) were successfully weaned from high-flow nasal oxygen therapy. While the high-flow nasal oxygen therapy failure rate was 23%, the in-hospital and 60-day mortality rates were 8.6%. Outcomes were not different between patients with and without pneumonia. CONCLUSION: High-flow nasal oxygen therapy was efficient in relieving respiratory distress and well-tolerated with no adverse outcome in severe acute exacerbation of chronic obstructive pulmonary disease patients admitted to the intensive care unit.