Impact of Decreasing Respiratory Rate While Tolerating Moderate Hypercapnia on Lung Injury Markers in Patients with Covid-19 Related Acute Respiratory Distress Syndrome

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dc.catalogadorjlo
dc.contributor.authorDamiani Rebolledo, Luis Felipe
dc.contributor.authorOviedo Álvarez, Vanessa Andrea
dc.contributor.authorAlegria Aguirre, Luz Katiushka
dc.contributor.authorBasoalto Escobar, Roque Ignacio
dc.contributor.authorBachmann Barron, María Consuelo
dc.contributor.authorJalil Contreras, Yorschua Frederick
dc.contributor.authorBruhn Cruz, Alejandro Rodrigo
dc.contributor.authorRetamal Montes, A.
dc.contributor.authorSantis Fuentes, César Antonio
dc.contributor.authorVera, M.
dc.contributor.authorBugedo Tarraza, Guillermo Jaime
dc.date.accessioned2025-12-12T16:22:02Z
dc.date.available2025-12-12T16:22:02Z
dc.date.issued2021
dc.description.abstractRationale: Acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 pneumonia is associated with a high mortality rate. Protective ventilationstrategies, by decreasing ventilator induced lung injury (VILI), have reduced mortality in patients with ARDS. However, the role of respiratory rate (RR), a centraldeterminant of the energy applied to the lung parenchyma remains uncertain. Objective: To evaluate the role of respiratory rate on systemic pro-inflammatory mediators, as markers of VILI, in patients with Covid-19-associated ARDS (CARDS) Methods: Prospective, randomized crossover trial in patients with CARDS,PaO2:FIO2 ratio less than 200 mmHg, and requiring deep sedation and neuromuscular blockade. All patients were ventilated with a tidal volume of 6 ml/kg IBW,and PEEP and FiO2 according to the ARDSNet table. If PaO2:FIO2 ratio was less than 150 mmHg, patients were positioned in the prone position.Two 12 hoursperiods with a low RR and a high RR, randomly selected, was conducted. Low RR and high RR periods were set to obtain an 8-10 breaths/min difference betweengroups while maintaining pH and PaCO2 within recommended limits. I:E ratio was held constant during the study.Hemodynamic and respiratory mechanics wereregistered, and arterial blood samples drawn for gas exchange and quantification of inflammatory biomarkers at baseline and repeated at 12 and 24 hours. Results: We enrolled 11 patients (10 males, median age 54 [51-66] years, PaO2:FIO2 108 [86-132]), and all of them were in prone position. The low RR (20 [16-23]) vs the high RR (28 [26-32]) was associated with a significantly lower energy applied to the lung (16 [12-19] vs 23 [20-32] J / min, respectively). PaCO2 and pH were kept within the recommended limits (pH 7.30 [7.25-7.35] vs 7.46 [7.43-7.50]; PaCO2 48 (45-63) vs 36 (32-38) mmHg for low and high RR, respectively).There were no significant changes in any of the respiratory mechanics parameters.The change in RR did not induce differences in any inflammatory marker (IL-6,IL-8, TNF-R1) or in the markers of epithelial (receptor for advanced glycation end products, s-RAGE; Surfactant protein D, SP-D), endothelial damage (Angiopoietin2) or the marker of profibrotic activity (transforming growth factor ß, TGF-ß) (table 1). Conclusion: These preliminary results reveal that a decrease in respiratoryrate, tolerating moderate hypercapnia, does not modify the biomarkers of lung damage compared to a strategy of high respiratory rate in patients with CARDS.
dc.description.funderFONDECYT
dc.fuente.origenWOS
dc.identifier.eissn1535-4970
dc.identifier.issn1073-449X
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/107386
dc.identifier.wosidWOS:000685468902025
dc.information.autorucEscuela de Medicina; Damiani Rebolledo, Luis Felipe; 0000-0002-8338-0488; 237645
dc.information.autorucEscuela de Medicina; Oviedo Álvarez, Vanessa Andrea; S/I; 1009275
dc.information.autorucEscuela de Química; Alegria Aguirre, Luz Katiushka; S/I; 3579
dc.information.autorucEscuela de Medicina; Basoalto Escobar, Roque Ignacio; 0000-0002-8908-7397; 1010703
dc.information.autorucEscuela de Medicina; Bachmann Barron, María Consuelo; 0000-0002-2006-0591; 215825
dc.information.autorucEscuela de Medicina; Jalil Contreras, Yorschua Frederick; 0000-0002-4993-7158; 1079709
dc.information.autorucEscuela de Medicina; Bruhn Cruz, Alejandro Rodrigo; 0000-0001-8034-1937; 741
dc.information.autorucEscuela de Medicina; Santis Fuentes, César Antonio; S/I; 1022040
dc.information.autorucEscuela de Medicina; Bugedo Tarraza, Guillermo Jaime; 0000-0001-7527-6202; 60490
dc.issue.numero9
dc.language.isoen
dc.nota.accesocontenido parcial
dc.relation.isformatofInternational Conference of the American-Thoracic-Society (ATS), MAY 14-19, 2021, ELECTR NETWORK
dc.revistaAmerican Thoracic Society International Conference Abstracts
dc.rightsacceso restringido
dc.subject.ddc610
dc.titleImpact of Decreasing Respiratory Rate While Tolerating Moderate Hypercapnia on Lung Injury Markers in Patients with Covid-19 Related Acute Respiratory Distress Syndrome
dc.typecomunicación de congreso
dc.volumen203
sipa.codpersvinculados237645
sipa.codpersvinculados1009275
sipa.codpersvinculados3579
sipa.codpersvinculados1010703
sipa.codpersvinculados215825
sipa.codpersvinculados1079709
sipa.codpersvinculados741
sipa.codpersvinculados1022040
sipa.codpersvinculados60490
sipa.trazabilidadWOS;18-03-2022
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