Mean airway pressure has the potential to become the core pressure indicator of mechanical ventilation: Raising to the front from behind the clinical scenes

Su, Longxiang; Pan, Pan; Liu, Dawei; Long, Yun

doi:10.1016/j.jointm.2021.04.002

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…High MAP could result in the overinflation of ventilated lung areas and the collapse of dead space, thus increasing mortality [ 61 , 62 ]. In addition, overdistended alveoli caused by a high MAP could also obstruct venous return and may result in right heart dysfunction through cardiopulmonary interactions, which was consistent with a previous study [ 63 – 65 ]. The FiO 2 /SpO 2 ratio, a noninvasive indicator, is a good substitute for the oxygenation index (PaO 2 /FiO 2 ratio) and can effectively identify critically ill patients in advance [ 66 – 70 ].…”

Section: Discussionsupporting

confidence: 92%

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study

Shi,

Fan

et al. 2023

j intensive care

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Background Heterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians’ ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective. Methods A group-based trajectory model was used to identify the OSI-trajectory phenotypes. Associations between the OSI-trajectory phenotypes and ICU mortality were analyzed using doubly robust analyses. Then, a predictive model was constructed to distinguish patients with poor prognosis phenotypes. Results Four OSI-trajectory phenotypes were identified in 3378 patients: low-level stable, ascending, descending, and high-level stable. Patients with the high-level stable phenotype had the highest mortality and fewest VFDs. The doubly robust estimation, after adjusting for unbalanced covariates in a model using the XGBoost method for generating propensity scores, revealed that both high-level stable and ascending phenotypes were associated with higher mortality rates (odds ratio [OR]: 1.422, 95% confidence interval [CI] 1.246–1.623; OR: 1.097, 95% CI 1.027–1.172, respectively), while the descending phenotype showed similar ICU mortality rates to the low-level stable phenotype (odds ratio [OR] 0.986, 95% confidence interval [CI] 0.940–1.035). The predictive model could help identify patients with ascending or high-level stable phenotypes at an early stage (area under the curve [AUC] in the training dataset: 0.851 [0.827–0.875]; AUC in the validation dataset: 0.743 [0.709–0.777]). Conclusions Dynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients.

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Section: Discussionsupporting

confidence: 92%

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study

Shi,

Fan

et al. 2023

j intensive care

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“…Therefore, in the process of related lung protection ventilation, the following circulation-protective procedures can be considered to guide our mechanical ventilation to achieve lower PPV, such as evaluating and treating the spontaneous breathing effort and respiratory support conditions and monitoring and optimizing the flow status and volume status of a patient. Combined with our previous studies ( 36 , 37 ), we propose a possible processing procedure for the PPV abnormalities, as shown in Figure 2 .…”

Section: Circulation-protective Ventilation Strategymentioning

confidence: 80%

PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

Pan

et al. 2021

Front. Med.

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Pulse pressure variation (PPV) is a mandatory index for hemodynamic monitoring during mechanical ventilation. The changes in pleural pressure (Ppl) and transpulmonary pressure (PL) caused by mechanical ventilation are the basis for PPV and lead to the effect of blood flow. If the state of hypovolemia exists, the effect of the increased Ppl during mechanical ventilation on the right ventricular preload will mainly affect the cardiac output, resulting in a positive PPV. However, PL is more influenced by the change in alveolar pressure, which produces an increase in right heart overload, resulting in high PPV. In particular, if spontaneous breathing is strong, the transvascular pressure will be extremely high, which may lead to the promotion of alveolar flooding and increased RV flow. Asynchronous breathing and mediastinal swing may damage the pulmonary circulation and right heart function. Therefore, according to the principle of PPV, a high PPV can be incorporated into the whole respiratory treatment process to monitor the mechanical ventilation cycle damage/protection regardless of the controlled ventilation or spontaneous breathing. Through the monitoring of PPV, the circulation-protective ventilation can be guided at bedside in real time by PPV.

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“…Airway pressure is equal to alveolar pressure in the resting state and depicts the pressure generated to overcome the retractive elastic forces of the pulmonary system. It is reflected in the following equation[ 19 , 20 ]; (airway pressure = flow x resistance + alveolar pressure).…”

Section: Pressurementioning

confidence: 99%

Driving pressure in mechanical ventilation: A review

Zaidi,

Shaikh,

Khan

et al. 2024

World J Crit Care Med

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Driving pressure (∆P) is a core therapeutic component of mechanical ventilation (MV). Varying levels of ∆P have been employed during MV depending on the type of underlying pathology and severity of injury. However, ∆P levels have also been shown to closely impact hard endpoints such as mortality. Considering this, conducting an in-depth review of ∆P as a unique, outcome-impacting therapeutic modality is extremely important. There is a need to understand the subtleties involved in making sure ∆P levels are optimized to enhance outcomes and minimize harm. We performed this narrative review to further explore the various uses of ∆P, the different parameters that can affect its use, and how outcomes vary in different patient populations at different pressure levels. To better utilize ∆P in MV-requiring patients, additional large-scale clinical studies are needed.

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Mean airway pressure has the potential to become the core pressure indicator of mechanical ventilation: Raising to the front from behind the clinical scenes

Cited by 9 publications

References 17 publications

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study

PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

Driving pressure in mechanical ventilation: A review

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