PEEP Incremental and Decremental Alveolar Recruitment of Critically Ill Corona Virus Disease-19 (COVID-19) Patients
Condition: COVID-19; Virus; Pneumonia; Atelectasis
MeSH terms: COVID-19; Pneumonia, Viral; Pulmonary Atelectasis
Study type: Interventional

Summary: 
      COVID-19 originated from Severe Acut Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)
      infection leads to critical condition due to hypoxemic respiratory failure with the
      background of viral pneumonia. Both alevolar recruitment and the subsequent optimal positive
      end-expiratory pressure (PEEP) adjustment has a pivotal role in the elimination of
      atelectasis developed by inflammation in the lung parenchyma The gold standard of the follow
      up of recruitment manoeuvre is the chest computed tomography (CT) examination. However,
      reduction of intrahospital transport and the exposure with healthcare workers are recommended
      because of the extremely virulent pathogen spreading easily by droplet infection. In this
      case bedside investigations have an utmost importance in the management of hygiene
      regulations.

      Electric impedance tomography (EIT) is a non-invasive, radiation free functional imaging
      technique easily applicable at the bedside.
    

Detailed description: 
      COVID-19 originated from Severe Acut Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)
      infection leads to critical condition in 5% of the cases due to hypoxemic respiratory failure
      with the background of viral pneumonia. 90% of these patients require invasive mechanical
      ventilation on critical care units. Both alevolar recruitment and the subsequent optimal
      positive end-expiratory pressure (PEEP) adjustment has a pivotal role in the eliminitaion of
      atelectasis developed by inflammation in the lung parenchyma.

      The gold standard of the follow up of recruitment manoeuvre is the chest computed tomography
      (CT) examination. However, reduction of intrahospital transport and the exposure with
      healthcare workers are recommended because of the extremely virulent pathogen spreading
      easily by droplet infection. In this case bedside investigations have an utmost importance in
      the management of hygiene regulations.

      Electric impedance tomography (EIT) is a non-invasive, radiation free functional imaging
      technique easily applicable at the bedside. With the help of EIT, intrathoracic impedance
      changes, resulting from air and blood volume variations, can be determined by
      circumferentially attached surface electrodes around the thorax, applying small alternating
      currents and measuring differences in surface potentials. The calculated difference in
      potential is utilised to reconstruct impedance images what is employed to assess ventilation
      and perfusion distribution. Several local and global variances can be estimated just like the
      ratio fo atelectatic/overdistended alveoli, the ratio of aeration in the anterior/posterior
      regions, the inhomogeneity of aeration or regional compliance.
    

Intervention name(s): alveolar recruitment
Intervention type(s): Procedure
Intervention description(s): incremental and decremental positive end-expiratory pressure alveolar recruitment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic