Prospective Observational Study to Evaluate the Effect of Different Levels of Positive End-Expiratory Pressure on Lung Mechanics in Patients with and without Acute Respiratory Distress Syndrome

Fiedler, Mascha O.; Diktanaite, Dovile; Simeliunas, Emilis; Pilz, Maximilian; Kalenka, Armin

doi:10.3390/jcm9082446

Cited by 3 publications

(4 citation statements)

References 39 publications

(39 reference statements)

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“…Measurement of the EELV was performed when the subject was put on a ventilator equipped with the ability to measure EELV (Engstrom, GE Healthcare, Chicago, Illinois). This was based on a previous report of a simplified and modified nitrogen multiple breath washout technique [19][20][21][22] integrated with an Engstrom ventilator, with breath-by-breath calculation of nitrogen-based on carbon dioxide production, end-tidal oxygen concentration, and end-tidal P aO 2 without using supplementary gases. After written informed consent was obtained, the ventilator settings were reduced to a pressure support level of #10 cm H 2 O and PEEP of 5 cm H 2 O with F IO 2 0.4, and the subject was observed for at least 8 h to ensure stable respiratory and hemodynamic conditions.…”

Section: Measurement Of Eelvs and Relevant Parametersmentioning

confidence: 99%

“…Traditional methods of measuring FRC or EELV include gas dilution, nitrogen washout, 16,17 body plethysmography, and computed tomography; 12,15,18 however, applying these approaches is difficult in patients on mechanical ventilation in the ICU. New techniques have been developed to address this issue, with the advantage of not interrupting breathing with mechanical ventilation, 15,19 : nitrogen multiple breath washout techniques integrated into ventilators, [19][20][21][22][23] electrical impedance tomography, 24,25 and the capnodynamic method. 26 Most previous studies on the correlation between the FRC or EELV and ventilator weaning focused on patients who were endotracheally intubated.…”

Section: Introductionmentioning

confidence: 99%

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End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation

et al. 2021

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BACKGROUND: The role of end-expiratory lung volume (EELV) during a spontaneous breathing trial (SBT) in patients who were tracheostomized and on prolonged mechanical ventilation is unclear. This study aimed to assess EELV during a 60-min SBT and its correlation with weaning success. METHODS: Enrolled subjects admitted to a weaning unit were measured for EELV and relevant parameters before and after the SBT. RESULTS: Of the 44 enrolled subjects, 29 (66%) were successfully liberated, defined as not needing mechanical ventilation for 5 d. The success group had fewer subjects with chronic kidney disease (41% vs 73%, P 5 .044), stronger mean 6 SD maximum inspiratory pressure (41.6 6 10.4 vs 34.1 6 7.1 cm H 2 O; P 5 .02) and mean 6 SD maximum expiratory pressure (46.9 6 11.7 vs 35.3 6 16.9 cm H 2 O; P 5 .01) versus the failure group. Toward the end of the SBT, the success group had a significant increase in the mean 6 SD EELV (before vs after: 1,278 6 744 vs 1,493 6 867 mL; P 5 .040) and a decrease in the mean 6 SD rapid shallow breathing index (83.8 6 39.4 vs 66.3 6 29.4; P 5 .02), whereas there were no significant changes in these 2 parameters in the failure group. The Cox regression analysis showed that, at the beginning of SBT, a greater difference between EELV with a PEEP of 0 cm H 2 O and with a PEEP of 5 cm H 2 O was significantly correlated to a higher likelihood of weaning success. Toward the end of the SBT, a greater EELV level at a PEEP of 0 cm H 2 O was also correlated with weaning success. Also, the greater difference of EELV at a PEEP of 0 cm H 2 O between the beginning and the end of the SBT was also correlated with a shorter duration to weaning success. CONCLUSIONS: The change in EELV during a 60-min SBT may be of prognostic value for liberation from prolonged mechanical ventilation in patients who had a tracheostomy. Our findings suggest a model to understand the underlying mechanism of failure of liberation from mechanical ventilation in these patients.

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Section: Measurement Of Eelvs and Relevant Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation

et al. 2021

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“…Initially, the physical interactions between the abdominal and thoracic compartments may seem obvious but are challenging to identify and to handle in clinical practice. Severe impairment of global respiratory parameters and an increase of mechanical load of the lungs have been found in patients with ARF due to IAH and primary ARDS, despite different components of the respiratory system being primarily affected [ 3 , 8 , 11 , 13 , 14 ]. Regarding respiratory mechanics, these different components include the lung and the chest wall [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Differential Effects of Intra-Abdominal Hypertension and ARDS on Respiratory Mechanics in a Porcine Model

Seybold,

Deutsch,

Deutsch

et al. 2024

Medicina

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Background and Objectives: Intra-abdominal hypertension (IAH) and acute respiratory distress syndrome (ARDS) are common concerns in intensive care unit patients with acute respiratory failure (ARF). Although both conditions lead to impairment of global respiratory parameters, their underlying mechanisms differ substantially. Therefore, a separate assessment of the different respiratory compartments should reveal differences in respiratory mechanics. Materials and Methods: We prospectively investigated alterations in lung and chest wall mechanics in 18 mechanically ventilated pigs exposed to varying levels of intra-abdominal pressures (IAP) and ARDS. The animals were divided into three groups: group A (IAP 10 mmHg, no ARDS), B (IAP 20 mmHg, no ARDS), and C (IAP 10 mmHg, with ARDS). Following induction of IAP (by inflating an intra-abdominal balloon) and ARDS (by saline lung lavage and injurious ventilation), respiratory mechanics were monitored for six hours. Statistical analysis was performed using one-way ANOVA to compare the alterations within each group. Results: After six hours of ventilation, end-expiratory lung volume (EELV) decreased across all groups, while airway and thoracic pressures increased. Significant differences were noted between group (B) and (C) regarding alterations in transpulmonary pressure (TPP) (2.7 ± 0.6 vs. 11.3 ± 2.1 cmH2O, p < 0.001), elastance of the lung (EL) (8.9 ± 1.9 vs. 29.9 ± 5.9 cmH2O/mL, p = 0.003), and elastance of the chest wall (ECW) (32.8 ± 3.2 vs. 4.4 ± 1.8 cmH2O/mL, p < 0.001). However, global respiratory parameters such as EELV/kg bodyweight (−6.1 ± 1.3 vs. −11.0 ± 2.5 mL/kg), driving pressure (12.5 ± 0.9 vs. 13.2 ± 2.3 cmH2O), and compliance of the respiratory system (−21.7 ± 2.8 vs. −19.5 ± 3.4 mL/cmH2O) did not show significant differences among the groups. Conclusions: Separate measurements of lung and chest wall mechanics in pigs with IAH or ARDS reveals significant differences in TPP, EL, and ECW, whereas global respiratory parameters do not differ significantly. Therefore, assessing the compartments of the respiratory system separately could aid in identifying the underlying cause of ARF.

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“…Increased chest wall elastance (E CW ) elevates P pl and may cause negative PL. As negative PL may lead to lung or airway collapse, adjusting PEEP to achieve positive end-expiratory PL prevents collapse and optimizes lung mechanics [ 3 , 4 , 11 , 12 ]. In general for this aim expiratory PL is used.…”

Section: Introductıonmentioning

confidence: 99%

Assessment of different computing methods of inspiratory transpulmonary pressure in patients with multiple mechanical problems

İnci

Boyacı

Kara

et al. 2021

J Clin Monit Comput

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While plateau airway pressure alone is an unreliable estimate of lung overdistension inspiratory transpulmonary pressure (PL) is an important parameter to reflect it in patients with ARDS and there is no concensus about which computation method should be used to calculate it. Recent studies suggest that different formulas may lead to different tidal volume and PEEP settings. The aim of this study is to compare 3 different inspiratory PL measurement method; direct measurement (PL D ), elastance derived (PL E ) and release derived (PL R ) methods in patients with multiple mechanical abnormalities. 34 patients were included in this prospective observational study. Measurements were obtained during volume controlled mechanical ventilation in sedated and paralyzed patients. During the study day airway and eosephageal pressures, flow, tidal volume were measured and elastance, inspiratory PL E , PL D and PL R were calculated. Mean age of the patients was 67 ± 15 years and APACHE II score was 27 ± 7. Most frequent diagnosis of the patients were pneumonia (71%), COPD exacerbation(56%), pleural effusion (55%) and heart failure(50%). Mean plateau pressure of the patients was 22 ± 5 cmH 2 O and mean respiratory system elastance was 36.7 ± 13 cmH 2 O/L. E L /E RS % was 0.75 ± 0.35%. Mean expiratory transpulmonary pressure was 0.54 ± 7.7 cmH 2 O (min: − 21, max: 12). Mean PL E (18 ± 9 H 2 O) was significantly higher than PL D (13 ± 9 cmH 2 O) and PL R methods (11 ± 9 cmH 2 O). There was a good aggreement and there was no bias between the measurements in Bland–Altman analysis. The estimated bias was similar between the PL D and PL E (− 3.12 ± 11 cmH 2 O) and PL E and PL R (3.9 ± 10.9 cmH 2 O) measurements. Our results suggest that standardization of calculation method of inspiratory PL is necessary before using it routinely to estimate alveolar overdistension.

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Prospective Observational Study to Evaluate the Effect of Different Levels of Positive End-Expiratory Pressure on Lung Mechanics in Patients with and without Acute Respiratory Distress Syndrome

Cited by 3 publications

References 39 publications

End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation

End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation

Differential Effects of Intra-Abdominal Hypertension and ARDS on Respiratory Mechanics in a Porcine Model

Assessment of different computing methods of inspiratory transpulmonary pressure in patients with multiple mechanical problems

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