Impact of liberal versus conservative saturation targets on gas exchange indices in COVID-19 related acute respiratory distress syndrome: a physiological study

Javier Hernán Dorado, Joaquín Pérez, Emiliano Navarro, Emiliano Gogniat, Sebastían Torres, Sabrina Cagide, Matías Accoce, Javier Hernán Dorado, Joaquín Pérez, Emiliano Navarro, Emiliano Gogniat, Sebastían Torres, Sabrina Cagide, Matías Accoce

Abstract

Objective: To compare gas exchange indices behavior by using liberal versus conservative oxygenation targets in patients with moderate to severe acute respiratory distress syndrome secondary to COVID-19 under invasive mechanical ventilation. We also assessed the influence of high FiO2 on respiratory system mechanics.

Methods: We prospectively included consecutive patients aged over 18 years old with a diagnosis of COVID-19 and moderate-severe acute respiratory distress syndrome. For each patient, we randomly applied two FiO2 protocols to achieve SpO2 88% - 92% or 96%. We assessed oxygenation indices and respiratory system mechanics.

Results: We enrolled 15 patients. All the oxygenation indices were significantly affected by the FiO2 strategy (p < 0.05) selected. The PaO2/FiO2 deteriorated, PA-aO2 increased and Pa/AO2 decreased significantly when using FiO2 to achieve SpO2 96%. Conversely, the functional shunt fraction was reduced. Respiratory mechanics were not affected by the FiO2 strategy.

Conclusion: A strategy aimed at liberal oxygenation targets significantly deteriorated gas exchange indices, except for functional shunt, in COVID-19-related acute respiratory distress syndrome. The respiratory system mechanics were not altered by the FiO2 strategy.Clinical Trials Register: NCT04486729.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figura 1
Figura 1
Oxygenation indices behavior with liberal and conservative oxygenation strategies.

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