Short-term mortality in COVID-19 patients ventilated with low and high PEEP: a retrospective observational study
Mortalidade a curto prazo em pacientes COVID-19 ventilados com PEEP baixa e alta: um estudo observacional retrospectivo
Alessandro Domingues Heubel, Stephanie Nogueira Linares, Viviane Volfi Carvalho, Karen Silva Lipi, Luciane Neves Silva Santos, Célio Guilherme Lombardi Daibem, Roberta Munhoz Manzano, Renata Gonçalves Mendes
Abstract
Background: During invasive mechanical ventilation (IMV), positive end-expiratory pressure (PEEP) is generally used to improve oxygenation, but it can also provide variable effects that contribute to lung injury. Although some studies have addressed the influence of PEEP on mortality, this has been poorly investigated in COVID-19 patients. Aim: To investigate whether initial ventilation with low or high levels of PEEP influences short-term mortality in invasively ventilated COVID-19 patients. Methods: Retrospective study including invasively ventilated COVID-19 patients hospitalized between April 2020 and July 2021. Demographic, clinical, and ventilatory variables were obtained from electronic medical records. Ventilator settings and parameters were assessed at fixed time points during the first 48 hours of IMV. Low and high PEEP were considered when < 10 cmH2O and ≥ 10 cmH2O, respectively. The primary outcome was 28-day mortality after endotracheal intubation. Results: Of 183 patients, 55 (30%) and 128 (70%) were ventilated with low and high PEEP, respectively. Kaplan-Meier analysis showed that the high PEEP group had lower 28-day mortality when compared with the low PEEP group (P < 0.001). After multivariate Cox regression analysis adjusting for potential confounders, the high PEEP group had a hazard ratio of 0.44 (95% CI of 0.28 to 0.70) for 28-day mortality, indicating a 56% lower risk of death compared with the low PEEP group. Conclusion: The use of PEEP ≥ 10 cmH2O was associated with higher short-term survival in this cohort of mechanically ventilated COVID-19 patients.
Keywords
Resumo
Introdução: Durante a ventilação mecânica invasiva (VMI), a pressão positiva expiratória final (PEEP) é geralmente utilizada para melhorar a oxigenação, mas também pode apresentar efeitos variáveis que contribuem para lesão pulmonar. Embora alguns estudos tenham abordado a influência da PEEP na mortalidade, isso foi pouco investigado em pacientes COVID-19. Objetivo: Investigar se a ventilação inicial com níveis baixos ou altos de PEEP influencia a mortalidade a curto prazo em pacientes COVID-19 em ventilação invasiva. Métodos: Estudo retrospectivo incluindo pacientes COVID-19 em VMI hospitalizados entre abril de 2020 e julho de 2021. Variáveis demográficas, clínicas e ventilatórias foram obtidas de prontuários eletrônicos. Configurações e parâmetros do ventilador foram avaliados em momentos fixos nas primeiras 48 horas de VMI. PEEP baixa e alta foram consideradas quando < 10 cmH2O e ≥ 10 cmH2O, respectivamente. O desfecho primário foi a mortalidade em 28 dias após a intubação endotraqueal. Resultados: Dos 183 pacientes, 55 (30%) e 128 (70%) foram ventilados com PEEP baixa e alta, respectivamente. A análise de Kaplan-Meier mostrou que o grupo PEEP alta teve menor mortalidade em 28 dias quando comparado ao grupo PEEP baixa (P < 0,001). Após análise de regressão multivariada de Cox ajustando para potenciais confundidores, o grupo PEEP alta apresentou hazard ratio de 0,44 (IC 95% de 0,28 a 0,70) para mortalidade em 28 dias, indicando um risco de morte 56% menor comparado ao grupo PEEP baixa. Conclusão: O uso de PEEP ≥ 10 cmH2O foi associado a maior sobrevida em curto prazo nesta coorte de pacientes COVID-19 ventilados mecanicamente.
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Referências
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Submetido em:
06/07/2025
Aceito em:
11/02/2026
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