How to recognize patients at risk of self-inflicted lung injury

Pettenuzzo, Tommaso; Sella, Nicolò; Zarantonello, Francesco; Cassai, Alessandro De; Geraldini, Federico; Persona, Paolo; Pistollato, Elisa; Boscolo, Annalisa; Navalesi, Paolo

doi:10.1080/17476348.2022.2128335

Cited by 3 publications

(1 citation statement)

References 87 publications

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“…Estimating excessive respiratory drive associated with spontaneous breathing is difficult to measure, and many of the variables used are qualitative measures or require dedicated ventilator respiratory monitoring not in routine clinical use. 24 Indeed, patient contribution will reduce ventilator requirements, and likely lead to an underestimation in total MP calculated using only ventilator data. When applying these calculations to the spontaneously breathing infant, this limitation will require consideration.…”

Section: Discussionmentioning

confidence: 99%

Mechanical power made simple: validating a simplified calculation of mechanical power in preterm lungs

Pearson-Lemme,

Halibullah,

Becher

et al. 2024

Pediatr Res

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Background The incidence of chronic lung disease is increasing, suggesting a need to explore novel ways to understand ventilator induced lung injury (VILI) in preterm infants. Mechanical power (MP) is a unifying measure of energy transferred to the respiratory system and a proposed determinant of VILI. The gold-standard method for calculating MP (geometric method) is not feasible in the clinical setting. This has prompted the derivation of simplified equations for calculating MP. Objective To validate the agreement between a simplified calculation of MP (MPSimple) and the true MP calculated using the geometric method (MPRef). Methods MPSimple and MPRef was calculated in mechanically ventilated preterm lambs (n = 71) and the agreement between both measures was determined using intraclass correlation coefficients (ICC), linear regression, and Bland-Altman analysis. Results A strong linear relationship (adjusted R2 = 0.98), and excellent agreement (ICC = 0.99, 95% CI = 0.98–0.99) between MPSimple and MPRef was demonstrated. Bland-Altman analysis demonstrated a negligible positive bias (mean difference = 0.131 J/min·kg). The 95% limits of agreement were −0.06 to 0.32 J/min·kg. Conclusions In a controlled setting, there was excellent agreement between MPSimple and gold-standard calculations. MPSimple should be validated and explored in preterm neonates to assess the cause-effect relationship with VILI and neonatal outcomes. Impact statement Mechanical power (MP) unifies the individual components of ventilator induced lung injury (VILI) and provides an estimate of total energy transferred to the respiratory system during mechanical ventilation. As gold-standard calculations of mechanical power at the bedside are not feasible, alternative simplified equations have been proposed. In this study, MP calculated using a simplified equation had excellent agreement with true MP in mechanically ventilated preterm lambs. These results lay foundations to explore the role of MP in neonatal VILI and determine its relationship with short and long term respiratory outcomes.

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Section: Discussionmentioning

confidence: 99%

Mechanical power made simple: validating a simplified calculation of mechanical power in preterm lungs

Pearson-Lemme,

Halibullah,

Becher

et al. 2024

Pediatr Res

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Non-invasive patient breathing effort identification: a b-spline and mixed integer solution

Lindup,

Chase,

Zhou

et al. 2024

IFAC-PapersOnLine

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PaCO2 is nonlinearly associated with NIV failure in patients with hypoxemic respiratory failure

Xu,

Ma,

Min

et al. 2024

BMC Pulm Med

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Objective To explore the association between PaCO2 and noninvasive ventilation (NIV) failure in patients with hypoxemic respiratory failure. Methods A retrospective study was performed in a respiratory ICU of a teaching hospital. Patients admitted to ICU between 2011 and 2019 were screened. We enrolled the patients with hypoxemic respiratory failure. However, patients who used NIV due to acute-on-chronic respiratory failure or heart failure were excluded. Data before the use of NIV were collected. Requirement of intubation was defined as NIV failure. Results A total of 1029 patients were enrolled in final analysis. The rate of NIV failure was 45% (461/1029). A nonlinear relationship between PaCO2 and NIV failure was found by restricted cubic splines (p = 0.03). The inflection point was 32 mmHg. The rate of NIV failure was 42% (224/535) in patients with PaCO2 >32 mmHg. However, it increased to 48% (237/494) in those with PaCO2 ≤ 32 mmHg. The crude and adjusted hazard ratio (HR) for NIV failure was 1.36 (95%CI:1.13–1.64) and 1.23(1.01–1.49), respectively, if the patients with PaCO2 >32 mmHg were set as reference. In patients with PaCO2 ≤ 32 mmHg, one unit increment of PaCO2 was associated with 5% reduction of NIV failure. However, it did not associate with NIV failure in patients with PaCO2 >32 mmHg. Conclusions PaCO2 and NIV failure was nonlinear relationship. The inflection point was 32 mmHg. Below the inflection point, lower PaCO2 was associated with higher NIV failure. However, it did not associate with NIV failure above this point.

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How to recognize patients at risk of self-inflicted lung injury

Cited by 3 publications

References 87 publications

Mechanical power made simple: validating a simplified calculation of mechanical power in preterm lungs

Mechanical power made simple: validating a simplified calculation of mechanical power in preterm lungs

Non-invasive patient breathing effort identification: a b-spline and mixed integer solution

PaCO2 is nonlinearly associated with NIV failure in patients with hypoxemic respiratory failure

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