Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study

Pintado, María-Consuelo; Pablo, Raúl de; Trascasa, María; Milicua, J.-M.; Rogero, S.; Daguerre, Martín; Cambronero, J. A.; Arribas, Ignacio; Sánchez-García, Miguel

doi:10.4187/respcare.02068

Cited by 120 publications

(82 citation statements)

References 42 publications

(57 reference statements)

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“…Pintado et al 39 recently reported a randomized controlled study to evaluate the effect of setting an individualized PEEP at the highest C RS . Subjects in the C RS -guided group had a nonsignificant improvement in 28-d mortality (21% vs 39%, P ϭ .12), perhaps because the study was underpowered.…”

Section: Respiratory Mechanics During Mechanical Ventilationmentioning

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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Section: Respiratory Mechanics During Mechanical Ventilationmentioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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“…Respiratory mechanics monitoring of critically ill patients receiving mechanical ventilation can be used to guide treatment and monitor changes in patient condition [1], [2]. The underlying respiratory mechanics of a patient, indicative of the lung condition, can be masked by any level of patient breathing effort [3].…”

Section: Introductionmentioning

confidence: 99%

A polynomial model of patient-specific breathing effort during controlled mechanical ventilation

Redmond

Docherty

Chiew

et al. 2015

2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Abstract-Patient breathing efforts occurring during controlled ventilation causes perturbations in pressure data, which cause erroneous parameter estimation in conventional models of respiratory mechanics. A polynomial model of patient effort can be used to capture breath-specific effort and underlying lung condition. An iterative multiple linear regression is used to identify the model in clinical volume controlled data. The polynomial model has lower fitting error and more stable estimates of respiratory elastance and resistance in the presence of patient effort than the conventional single compartment model. However, the polynomial model can converge to poor parameter estimation when patient efforts occur very early in the breath, or for long duration. The model of patient effort can provide clinical benefits by providing accurate respiratory mechanics estimation and monitoring of breath-to-breath patient effort, which can be used by clinicians to guide treatment.

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“…31 In comparison to patients receiving PEEP according to the ARDS Network F IO 2 /PEEP table, Pintado et al found significantly fewer days of multi-organ system dysfunction and hemodynamic failure, as well as more ventilator-free days. There was a trend toward decreased mortality.…”

Section: See the Original Study On Page 1416mentioning

confidence: 99%