Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2

Franck, Cláudio Luciano; Franck, Gustavo Maysonnave

doi:10.5935/0103-507x.20220018-en

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…Driving pressure is considered a predictor of mortality that may not change with prone positioning, 30 however, reductions in transpulmonary driving pressure have been demonstrated to be more reliable due to its greater precision of the exclusion of the chest wall component and present the stress applied to the lung parenchyma. 31 Prone positioning is considered a good strategy to reduce VILI, as titrating PEEP to lower values during prone positioning correlates with a reduction in transpulmonary driving pressure and mechanical power.…”

Section: Discussionmentioning

confidence: 99%

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Franck,

Daoud

2024

JMV

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Background Prone position has many documented benefits on severe ARDS patients especially on mortality. The benefits in ARDS secondary to severe burns have not been fully documented. Aim To quantify the effects of prone positioning on gas exchange, ventilatory mechanics and their correlations with mechanical power in burn subjects with ARDS. Methods Cross-sectional observational analytical study that took place between January 2023 and October 2023 in Burns ICU in Brazil on subjects with moderate to severe ARDS ventilated with the volume controlled mode. Data were collected in the first prone positioning lasting 24 hours in the first 30 minutes after changing position and 30 minutes before returning to the supine position. The parameters of the components of mechanical ventilation and mechanical power calculated by the Gatinoni’s formula (respiratory rate, tidal volume, driving pressure, PEEP, peak and plateau pressures) were collected to evaluate ventilatory mechanics, and the values of the FiO2, PaO2, PaO2/FiO2 ratio, SpO2, EtCO2, PaCO2, PaCO2 - EtCO2 gradient to assess gas exchange. Mean, minimum and maximum values, 1st and 3rd quartiles, median and standard deviation are calculated. To compare the results obtained at the two evaluation moments, the student’s t-test for dependent samples and non-parametric Wilcoxon tests were considered. To evaluate the association between the variation between the two moments of each variable, and the variation in mechanical power, the Pearson correlation coefficient was calculated. The normality of the variables was assessed using the Jarque-Béra test. P values <0.05 indicated statistical significance. Results Except for EtCO2 (P 0.939) and PaCO2 (P 0.391) all other variables presented statistical significance in relation to their variations with reduction in FiO2 (P <0.001), reduction in PaCO2 - EtCO2 gradient (P 0.011), and increases in PaO2 (P 0.008), PaO2/FiO2 (P <0.001), SpO2 (P 0.004). In the analysis of variables, reduction in respiratory rate (P 0.142), VT (P 0.385), peak pressure (P 0.085), plateau pressure (P 0.009), PEEP (P 0.032), driving pressure (P 0.083), elastance (P 0.180), mechanical power (P < 0.001) with increase static compliance (P 0.414) and resistance pressure (P 0.443). Among the ventilatory mechanics variables, only the reductions in plateau pressure, PEEP, and mechanical power showed statistical significance. Conclusion The prone position in burns induced ARDS improved oxygenation and reduced arterial partial pressure to end tidal CO2 gradient, furthermore, reducing plateau pressures and PEEP, which in turn reduced mechanical power. Keywords: mechanical power, burns, ARDS, prone position

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Section: Discussionmentioning

confidence: 99%

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Franck,

Daoud

2024

JMV

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“…According to Chi and colleagues, 20 As Franck & Franck have pointed out, 23 the correlations between components and MP have an influence on their high momentary values and correlations of components amongst each other influenced their behavior throughout the study period. In this research, we demonstrated that the mortality was related to higher values of MP, both in short and extended periods of ventilation.…”

Section: Discussionmentioning

confidence: 99%

Analysis of mechanical power during pressure-controlled ventilation in patients with severe burns

Simonete,

Alberti da Silva,

Franck

2023

JMV

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Introduction The clinical evolution of severe burns can lead to Acute Respiratory Distress Syndrome (ARDS) with increased requirements for mechanical ventilation, which may lead to the development of Ventilator-Induced Lung Injury (VILI). Together, ARDS and VILI may cause irreversible lung damage. Mechanical power measures the amount of energy transferred from the ventilator to the respiratory system and is considered to be a unifying concept of the etiology VILI. However, doubts are still to be clarified. The goals of this study were to analyze pressure-controlled ventilation (PCV) in severe burn injury patients, to associate the mechanical power values over time with the outcome of burn patients (death or survival) and to associate the components of ventilation with the outcome of burn patients. Methods A longitudinal, observational and analytical study of 172 measurements of parameters collected daily from the ventilators of 26 severe burn patients undergoing mechanical ventilation with PCV. Statistical analysis was performed on the obtained values and the components of mechanical ventilation in relation to the outcome of the patients. Results The mechanical power calculated daily in burn patients was 22.83 ± SD joule per minute (J/min). Higher values of mechanical power were significantly related to the mortality (P 0.029) regardless of ventilation time, as well as higher values of PEEP, peak pressure, plateau pressure and driving pressure ( P <0.001), respiratory rate (P 0.01), variation of inspiratory pressure (P 0.03) and lower values of tidal volume (P 0.005). Conclusion In this analysis of mechanical ventilation, mean values of mechanical power in burn patients were elevated and that, regardless of mechanical ventilation time, these values are related to mortality, as well as higher values of pressures, driving pressure, respiratory rate and lower values of tidal volume, indicating the importance of stress frequency and propulsion force to overcome lung elastance.

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Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2

Cited by 2 publications

References 20 publications

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Analysis of mechanical power during pressure-controlled ventilation in patients with severe burns

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