Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome

Terragni, Pierpaolo; Filippini, Claudia; Slutsky, Arthur S.; Birocco, Alberto; Tenaglia, T.; Grasso, Salvatore; Stripoli, Tania; Pasero, Daniela; Urbino, Rosario; Fanelli, Vito; Faggiano, Chiara; Mascia, Luciana; Ranieri, V. Marco

doi:10.1097/aln.0b013e3182a05bb8

Cited by 66 publications

(62 citation statements)

References 48 publications

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“…5,6 Some studies have reported regional overdistention even with P plat Ͻ30 cm H 2 O, suggesting that there might not be a safe P plat . 7,8 Thus, the lungs should be ventilated with P plat as low as possible. Moreover, there is evidence supporting the use of a V T of 6 mL/kg predicted body weight in all mechanically ventilated patients and suggesting that large V T might contribute to the development of ARDS.…”

Section: Introductionmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

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Section: Introductionmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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“…The results of a recent study using computed tomography to identify over-distention reported that injurious ventilation was associated with a P plat of Ͼ 25 cm H 2 O and a stress index of Ͼ 1.05. 6 …”

Section: Stress Indexmentioning

confidence: 99%

“…P plat should ideally be kept at Յ 30 cm H 2 O, 5 with some evidence suggesting that P plat should be targeted to Ͻ 25 cm H 2 O in patients with ARDS. 6,7 This assumes that chest-wall compliance (C CW ) is normal. A high P plat may be safe (and necessary) if C CW is decreased.…”

Section: Plateau Pressurementioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the RESPIRATORY CARE • NOVEMBER 2014 VOL 59 NO 11 1773 setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressuretime curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.

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“…Terragni et al assessed the accuracy of plateau pressure and stress index to identify the point associated with injurious ventilation. This study demonstrated that plateau pressure (Pplat) more than 25 cm H 2 O and stress index more than 1.05 have been shown the best performance to define the injurious ventilation (50). In terms of lung strain, the reference value computed by the ventilator is still controversial.…”

Section: Respiratory Mechanics and Esophageal Pressure Measurementmentioning

confidence: 99%

Protective mechanical ventilation in patients without or with lung injury

Sutherasan¹,

Vargas²,

Rodríguez-González³

et al. 2014

SANAMED

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Abstract:The mortality of Acute Respiratory Distress Syndrome (ARDS) is still high from 27 to 45% according to Berlin definition. Even in surgical patients without lung injury, the postoperative pulmonary complications (PPCs) are frequent. Mechanisms of ARDS, ventilator associated lung injury (VALI) and PPCs are better understood. In ARDS, protective ventilation with low tidal volume 6 ml/kg PBW and higher levels of positive end-expiratory pressure (PEEP) is widely accepted as routine practice. In no ARDS patients undergoing mechanical ventilation, protective ventilation with low tidal volume 6ml/kg PBW and low to moderate levels of PEEP has become the new challenge paradigm shift of supportive care mainly in ICU and perioperative patients. Respiratory monitoring is very helpful for optimizing mechanical ventilator setting to prevent VALI and early detect PPCs during the perioperative period. Several scores have been developed to stratify the risk of ARDS, VALI and PPCs. It's time to apply basic physiologic knowledge of respiratory function and evidence based practice to improve ARDS and PPCs outcomes.

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Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome

Cited by 66 publications

References 48 publications

Recruitment Maneuvers and PEEP Titration

Recruitment Maneuvers and PEEP Titration

Respiratory Mechanics in Mechanically Ventilated Patients

Protective mechanical ventilation in patients without or with lung injury

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