Researchers examining the effects of PEEP titration and prone positioning in early COVID-19 ARDS patients undergoing mechanical ventilation found both protocols were as effective treating these patients as those with classic ARDS, according to data published in The Lancet.

Researchers assessed fifteen COVID-19 positive patients with ARDS over the first 15 days of mechanical ventilation. Researchers said high PEEP was required for optimal oxygenation:

• Decremental PEEP trials were performed in 7 ventilated patients to identify the optimal PEEP
• PEEP trials were performed between 2 h and 60 h after initiation of mechanical ventilation.
• The optimal PEEP level was 17·9 (SD ± 3·6) mbar, which was slightly above the corresponding recommended PEEP according to the ARDSnet high PEEP table (16 mbar for FiO2 of 0·4 – 0·5). 

Prone positioning was also assessed in nine of the patients and data showed:

• 9 consecutive mechanically ventilated patients were subjected to prone maneuvers.
• In all analyses, PaO2/FiO2 ratio and OI were markedly improved in prone compared to the preceding supine position
• The optimal PEEP was slightly lower in prone positioning

“Our findings suggest that patients with early COVID-19 ARDS do not differ in their response to high PEEP and prone positioning from classic ARDS, and should therefore be ventilated according to established ARDS principles and regimens,” the researchers concluded.