Transpulmonary pressure and lung elastance can be estimated by a <scp>PEEP</scp>‐step manoeuvre

Lundin, S.; Grivans, Christina; Stenqvist, O.

doi:10.1111/aas.12442

Cited by 24 publications

(48 citation statements)

References 39 publications

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“…Therefore, specific elastance could be calculated by multiplying elastance by FRC, in which elastance is calculated as delta PEEP divided by delta EELV. Recently, Lundin et al 13. confirmed this method in 12 ARDS patients.…”

Section: Discussionmentioning

confidence: 92%

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Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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BackgroundStress and strain are parameters to describe respiratory mechanics during mechanical ventilation. Calculations of stress require invasive and difficult to perform esophageal pressure measurements. The hypothesis of the present study was: Can lung stress be reliably calculated based on non‐invasive lung volume measurements, during a decremental Positive end‐expiratory pressure (PEEP) trial in mechanically ventilated patients with different diseases?MethodsData of 26 pressure‐controlled ventilated patients admitted to the ICU with different lung conditions were retrospectively analyzed: 11 coronary artery bypass graft (CABG), 9 neurology, and 6 lung disorders. During a decremental PEEP trial (from 15 to 0 cmH2O in three steps) end‐expiratory lung volume (EELV) measurements were performed at each PEEP step, without interruption of mechanical ventilation. Strain, specific elastance, and stress were calculated for each PEEP level. Elastance was calculated as delta PEEP divided by delta PEEP volume, whereas specific elastance is elastance times the FRC. Stress was calculated as specific elastance times the strain. Global strain was divided into dynamic (tidal volume) and static (PEEP) strain.ResultsStrain calculations based on FRC showed mainly changes in static component, whereas calculations based on EELV showed changes in both the static and dynamic component of strain. Stress calculated from EELV measurements was 24.0 ± 2.7 and 13.1 ± 3.8 cmH2O in the lung disorder group at 15 and 5 cmH2O PEEP. For the normal lungs, the stress values were 19.2 ± 3.2 and 10.9 ± 3.3 cmH2O, respectively. These values are comparable to earlier publications. Specific elastance calculations were comparable in patients with neurologic and lung disorders, and lower in the CABG group due to recruitment in this latter group.ConclusionStress and strain can reliably be calculated at the bedside based on non‐invasive EELV measurements during a decremental PEEP trial in patients with different diseases.

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Section: Discussionmentioning

confidence: 92%

“…As we analyzed data of lung volume measurements from earlier studies with a different research question, the study design has some limitations: Firstly, we did not measure esophagus pressures in the present study and compared our data with previous published data 6, 13. Secondly, Stenqvist et al.…”

Section: Discussionmentioning

confidence: 96%

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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“…It was 0.81 for PEEP 9 cmH 2 O and 0.88 for PEEP 15 cmH 2 O. These ratios indicate that patients in the present study were extremely “pulmonary.” Regrettably, we did not measure the actual changes in end‐expiratory lung volume (EELV) on our patients but recently it has been shown that ∆EELV = Clung × ∆PEEP . Using this method, we calculated that the ∆EELV was only 202 ml when comparing PEEP 9 and 15 cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

“…We did not measure transpulmonary pressure ( P L ) at zero end‐expiratory pressure (ZEEP). However, if we assume, according to previous authors, that the change in end‐expiratory P L between ZEEP and PEEP 9 cmH 2 O, and between ZEEP and PEEP 15 cmH 2 O, was 9 and 15 cmH 2 O, respectively, we can calculate the ratio of end‐inspiratory P L /airway pressure, P L / P AW . It was 0.81 for PEEP 9 cmH 2 O and 0.88 for PEEP 15 cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

High PEEP levels are associated with overdistension and tidal recruitment/derecruitment in ARDS patients

Retamal

Bugedo

Larsson

et al. 2015

Acta Anaesthesiol Scand

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“…Accordingly, in early mild diffuse ARDS, Grasso observes that increasing PEEP lowers driving pressure [92]. A meta-analysis [169] confirms that the higher the predicted mortality, the greater the mortality reduction associated with high PEEP: the sicker the patients, the higher the PEEP should be viii) Recently, transpulmonary pressure was estimated without the use of an esophageal catheter [133]. This last method awaits independent validation.…”

Section: A Peep Peep [4[ (mentioning

confidence: 96%

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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Transpulmonary pressure and lung elastance can be estimated by a PEEP‐step manoeuvre

Cited by 24 publications

References 39 publications

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

High PEEP levels are associated with overdistension and tidal recruitment/derecruitment in ARDS patients

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

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