Titration and characteristics of pressure-support ventilation use in Argentina: an
            online cross-sectional survey study

Pérez, José Carlos Alcalde; Dorado, Javier Hernán; Papazian, Ana Carolina; Berastegui, Maricel; Gilgado, D; Cardoso, Gimena Paola; Cesio, Cristián Emanuel; Accoce, Matías

doi:10.5935/0103-507x.20200013

Cited by 7 publications

(7 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At present, a standardized approach for personalized PEEP in SMV is lacking. Current PEEP strategies are partially subjective and based on global lung parameters, such as the airway occlusion pressure (which is considered a surrogate for work of breathing), tidal volumes, and oxygenation status (32)(33)(34)(35). These approaches may ultimately lead to suboptimal ventilatory strategies and potentially unnecessary lung injury.…”

Section: Discussionmentioning

confidence: 99%

Regional peak flow as a novel approach to assess regional pulmonary mechanics by electrical impedance tomography: an observational validation study

Jongh¹,

Heines²,

Jongh³

et al. 2023

Ann Transl Med

View full text Add to dashboard Cite

Background: Spontaneous breathing efforts during mechanical ventilation are a widely accepted weaning approach for acute respiratory distress syndrome (ARDS) patients. These efforts can be too vigorous, possibly inflicting lung and diaphragm damage. Higher positive end expiratory pressure (PEEP) levels can be used to lower the magnitude of vigorous breathing efforts. Nevertheless, PEEP titrating tools are lacking in spontaneous mechanical ventilation (SMV). Therefore, the aim is to develop an electrical impedance tomography (EIT) algorithm for quantifying regional lung mechanics independent from a stable plateau pressure phase based on regional peak flow (RPF) by EIT, which is hypothetically applicable in SMV and to validate this algorithm in patients on controlled mechanical ventilation (CMV). Methods:The RPF algorithm quantifies a cumulative overdistension (OD RPF ) and collapse (CL RPF ) rate and is validated in a prospective cohort of mechanically ventilated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients on CMV. OD RPF and CL RPF are compared with compliance-based cumulative overdistension (OD P500 ) and collapse (CL P500 ) rates from the Pulmovista 500 EIT device at multiple PEEP levels (PEEP 10 cmH 2 O to PEEP 24 cmH 2 O) in EIT measurements from CMV patients by linear mixed models, Bland-Altman analysis and intraclass correlation coefficient (ICC).Results: Seventy-eight patients were included. Linear mixed models revealed an association between OD RPF and OD P500 of 1.02 (0.98-1.07, P<0.001) and between CL RPF and CL P500 of 0.93 (0.80-1.05, P<0.001).ICC values ranged from 0.78 to 0.86 (P<0.001) for OD RPF and OD P500 and from 0.70 to 0.85 (P<0.001) for CL RPF and CL P500 (PEEP 10 to PEEP 24). The mean bias between OD RPF and OD P500 in these PEEP levels ranged from 0.80% to 4.19% and from −1.31% to 0.13% between CL RPF and CL P500 .Conclusions: A RPF approach for quantifying regional lung mechanics showed a moderate to good agreement in coronavirus disease 2019 (COVID-19) related ARDS patients on CMV compared to the compliance-based approach. This, in addition to being independent of a plateau pressure phase, indicates that the RPF approach is a valid method to explore for quantifying regional lung mechanics in SMV.

show abstract

Section: Discussionmentioning

confidence: 99%

Regional peak flow as a novel approach to assess regional pulmonary mechanics by electrical impedance tomography: an observational validation study

Jongh¹,

Heines²,

Jongh³

et al. 2023

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…The C rs was recently proposed by Vaporidi et al as a bedside parameter to assess the risk of developing high values of ∆P aw during assisted ventilation. ( 6 ) Values lower than 20mL/cmH 2 O are unfailingly associated with periods of ∆P aw > 15cmH 2 O; on the other hand, high ∆P aw values are unlikely when C rs is higher than 30mL/cmH 2 O. Thus, below this C rs threshold, it is recommended to use advanced monitoring tools to avoid injurious spontaneous efforts.…”

Section: Discussionmentioning

confidence: 99%

“…There is a gap of knowledge regarding which ventilatory variables allow clinicians to detect the aptitude to breathe spontaneously and to identify the risk of P-SILI in patients recovering from ARDS. ( 4 , 6 ) Single parameters, such as oxygenation, respiratory drive, respiratory system (RS) mechanics and the work of breathing (WOB), have been proposed as potential promoters of P-SILI; ( 2 , 4 , 7 ) however, all of them remain controversial and there is no strong scientific evidence in their favor. ( 4 )…”

Section: Introductionmentioning

confidence: 99%

Self-inflicted lung injury: is it possible to identify the risk? A case report

Pérez

Dorado²,

Navarro

et al. 2021

Revista Brasileira De Terapia Intensiva

Self Cite

View full text Add to dashboard Cite

A respiração espontânea pode ser prejudicial para pacientes com pulmões previamente lesados, especialmente na vigência de síndrome do desconforto respiratório agudo. Mais ainda, a incapacidade de assumir a respiração totalmente espontânea durante a ventilação mecânica e a necessidade de voltar à ventilação mecânica controlada se associam com mortalidade mais alta. Existe uma lacuna no conhecimento em relação aos parâmetros que poderiam ser úteis para predizer o risco de lesão pulmonar autoinflingida pelo paciente e detecção da incapacidade de assumir a respiração espontânea. Relata-se o caso de um paciente com lesão pulmonar autoinflingida e as correspondentes variáveis, básicas e avançadas, de monitoramento da mecânica do sistema respiratório, além dos resultados fisiológicos e clínicos relacionados à respiração espontânea durante ventilação mecânica. O paciente era um homem caucasiano com 33 anos de idade e história clínica de AIDS, que apresentou síndrome do desconforto respiratório agudo e necessitou ser submetido à ventilação mecânica invasiva após falha do suporte ventilatório não invasivo. Durante os períodos de ventilação controlada, adotou-se estratégia de ventilação protetora, e o paciente mostrou evidente melhora, tanto do ponto de vista clínico quanto radiográfico. Contudo, durante cada período de respiração espontânea sob ventilação com pressão de suporte, apesar dos parâmetros iniciais adequados, das regulagens rigorosamente estabelecidas e do estrito monitoramento, o paciente desenvolveu hipoxemia progressiva e piora da mecânica do sistema respiratório, com deterioração radiográfica claramente correlacionada (lesão pulmonar autoinflingida pelo paciente). Após falha de três tentativas de respiração espontânea, o paciente faleceu por hipoxemia refratária no 29° dia. Neste caso, as variáveis básicas e avançadas convencionais não foram suficientes para identificar a aptidão para respirar espontaneamente ou predizer o risco de desenvolver lesão pulmonar autoinflingida pelo paciente durante a ventilação de suporte parcial.

show abstract

“…Bedside evaluation of potential injurious low effort is challenging. Indeed, the absence of signs related to respiratory workload (respiratory distress or recruitment of accessory respiratory muscles) is not sufficient: most over-assisted patients appear calm and comfortable [ 5 , 6 ]. Therefore, early detection of low effort is essential for the appropriate management of patients receiving PSV.…”

Section: Introductionmentioning

confidence: 99%

Validation of the flow index to detect low inspiratory effort during pressure support ventilation

Miao

Chen

Zhou

et al. 2022

Ann. Intensive Care

View full text Add to dashboard Cite

Background Bedside assessment of low levels of inspiratory effort, which are probably insufficient to prevent muscle atrophy, is challenging. The flow index, which is derived from the analysis of the inspiratory portion of the flow–time waveform, has been recently introduced as a non-invasive parameter to evaluate the inspiratory effort. The primary objective of the present study was to provide an external validation of the flow index to detect low inspiratory effort. Methods Datasets containing flow, airway pressure, and esophageal pressure (Pes)–time waveforms were obtained from a previously published study in 100 acute brain-injured patients undergoing pressure support ventilation. Waveforms data were analyzed offline. A low inspiratory effort was defined by one of the following criteria, work of breathing (WOB) less than 0.3 J/L, Pes–time product (PTPes) per minute less than 50 cmH2O•s/min, or inspiratory muscle pressure (Pmus) less than 5 cmH2O, adding “or occurrence of ineffective effort more than 10%” for all criteria. The flow index was calculated according to previously reported method. The association of flow index with Pes-derived parameters of effort was investigated. The diagnostic accuracy of the flow index to detect low effort was analyzed. Results Moderate correlations were found between flow index and WOB, Pmus, and PTPes per breath and per minute (Pearson’s correlation coefficients ranged from 0.546 to 0.634, P < 0.001). The incidence of low inspiratory effort was 62%, 51%, and 55% using the definition of WOB, PTPes per minute, and Pmus, respectively. The area under the receiver operating characteristic curve for flow index to diagnose low effort was 0.88, 0.81, and 0.88, for the three respective definition. By using the cutoff value of flow index less than 2.1, the diagnostic performance for the three definitions showed sensitivity of 0.95–0.96, specificity of 0.57–0.71, positive predictive value of 0.70–0.84, and negative predictive value of 0.90–0.93. Conclusions The flow index is associated with Pes-based inspiratory effort measurements. Flow index can be used as a valid instrument to screen low inspiratory effort with a high probability to exclude cases without the condition.

show abstract

Titration and characteristics of pressure-support ventilation use in Argentina: an online cross-sectional survey study

Cited by 7 publications

References 38 publications

Regional peak flow as a novel approach to assess regional pulmonary mechanics by electrical impedance tomography: an observational validation study

Regional peak flow as a novel approach to assess regional pulmonary mechanics by electrical impedance tomography: an observational validation study

Self-inflicted lung injury: is it possible to identify the risk? A case report

Validation of the flow index to detect low inspiratory effort during pressure support ventilation

Contact Info

Product

Resources

About