Plateau Pressure and Driving Pressure in Volume- and Pressure-Controlled Ventilation: Comparison of Frictional and Viscoelastic Resistive Components in Pediatric Acute Respiratory Distress Syndrome

Cruces, Pablo; Moreno, Diego A.; Reveco, Sonia; Ramírez, Yenny; Díaz, Franco

doi:10.1097/pcc.0000000000003291

Pediatric Critical Care Medicine

2023

DOI: 10.1097/pcc.0000000000003291

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Plateau Pressure and Driving Pressure in Volume- and Pressure-Controlled Ventilation: Comparison of Frictional and Viscoelastic Resistive Components in Pediatric Acute Respiratory Distress Syndrome

Pablo Cruces¹,

Diego A. Moreno²,

Sonia Reveco³

et al.

Abstract: To examine frictional, viscoelastic, and elastic resistive components, as well threshold pressures, during volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in pediatric patients with acute respiratory distress syndrome (ARDS). DESIGN: Prospective cohort study.SETTING: Seven-bed PICU,

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Cited by 8 publications

References 35 publications

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Peak inspiratory pressure lacks accuracy to estimate plateau pressure in infants with severe obstructive lower airway disease

Buratti,

Andreolio,

Bruno

et al. 2024

Pediatric Pulmonology

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PurposeIn children with acute respiratory distress syndrome receiving mechanical ventilation, the peak inspiratory pressure (PIP) is close to plateau pressure (PPLAT) when inspiratory flow approaches zero. We aimed to evaluate the reliability of PIP to estimate PPLAT in infants with severe respiratory viral infection (SRVI), characterized by increased airway resistance, and the accuracy of an equational model to estimates PPLAT (ePPLAT) based on PIP.MethodsThis was a retrospective observational study including mechanically ventilated children (1 to 24 month old) with SRVI, whose respiratory mechanics measurements were performed to evaluate PIP and PPLAT. The measured PPLAT was compared with the result of the equation: ePPLAT = PIP – [5.067 – (0.858 × static compliance) – (0.018 × inspiratory resistance) – (0.390 × pressure above positive‐end expiratory pressure) + (4.989 × inspiratory time)].ResultsThirty‐seven patients were included, with a median age of 3 (2–5) months. They presented a high inspiratory and expiratory resistance (136 ± 43 and 168 ± 66 cmH2O/L/s, respectively) and a moderate reduction in static compliance: 0.75 ± 0.3 mL/kg/cmH2O. PIP overestimated PPLAT (33 ± 3 and 26 ± 5 cmH2O, p = 0.01), with a mean difference of 7.3 ± 4 cmH2O. Moreover, the Bland‐Altman analysis demonstrated a mean difference between PPLAT and ePPLAT of 1.0 ± 4.0 cmH2O, with 95% limits of agreement of –6.9 and 8.8.ConclusionsA significant difference between PIP and PPLAT was observed in infants with SRVI. The equation model was inaccurate for estimating PPLAT based on PIP. Any estimation of PPLAT from PIP needs to consider the resistance component of the respiratory system.

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Peak inspiratory pressure lacks accuracy to estimate plateau pressure in infants with severe obstructive lower airway disease

Buratti,

Andreolio,

Bruno

et al. 2024

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

Critical Asthma in Infancy and Toddlers: How Can We Mechanically Discriminate From Critical Bronchiolitis?

Cruces,

Alcántar,

Caviedes

et al. 2024

Pediatric Pulmonology

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Association Between Tidal Volume in Invasive Mechanical Ventilation and Mortality in Children With Extracorporeal Membrane Oxygenation

Guijarro,

Fernández-Sarmiento,

Acevedo

et al. 2024

ASAIO Journal

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Mechanical ventilation (MV) strategies in children on extracorporeal membrane oxygenation (ECMO) have not been studied much and the ventilatory parameters to avoid greater lung damage are still unclear. Our objective was to determine the relationship between conventional tidal volume (4–8 ml/kg, CTV) versus low tidal volume (<4 ml/kg, LTV) and mortality in children with MV at the beginning of ECMO. This was a retrospective cohort study that included 101 (10.9 months interquartile range [IQR]: 6.0–24.0) children. Children with LTV had greater odds of hospital mortality (adjusted odds ratio [aOR]: 2.45; 95% confidence interval [CI]: 1.05–5.71; p = 0.03) regardless of age, reason for ECMO, and disease severity, as well as a longer duration of MV after ECMO. We found no differences between the groups in other MV settings. The CTV group required fewer fibrobronchoscopies than patients with LTV (aOR: 0.38; 95% CI: 0.15–0.99; p = 0.04). We found that a tidal volume (VT) lower than 4 ml/kg at the onset of ECMO support in children with MV was associated with higher odds of mortality, longer post-decannulation ventilation, and a greater need for fibrobronchoscopies. Lung-protective bundles in patients with ECMO and MV should consider the VT to maintain plateau and driving pressure that avoid major lung injury caused by MV.

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Plateau Pressure and Driving Pressure in Volume- and Pressure-Controlled Ventilation: Comparison of Frictional and Viscoelastic Resistive Components in Pediatric Acute Respiratory Distress Syndrome

Cited by 8 publications

References 35 publications

Peak inspiratory pressure lacks accuracy to estimate plateau pressure in infants with severe obstructive lower airway disease

Peak inspiratory pressure lacks accuracy to estimate plateau pressure in infants with severe obstructive lower airway disease

Critical Asthma in Infancy and Toddlers: How Can We Mechanically Discriminate From Critical Bronchiolitis?

Association Between Tidal Volume in Invasive Mechanical Ventilation and Mortality in Children With Extracorporeal Membrane Oxygenation

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