Tracheal Occlusion Pressure: A Simple Index to Monitor Respiratory Muscle Fatigue during Acute Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease

Murciano, D; Boczkowski, Jorge; Lecocguic, Y; Emili, J. Milic; Parienté, R; Aubier, Michel

doi:10.7326/0003-4819-108-6-800

Cited by 119 publications

(44 citation statements)

References 18 publications

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“…The increased P0.1 during ARF is in agreement with previous studies [22]. Although P0.1 was larger in FW compared to SW patients, in contrast to other studies [23][24][25], the difference in mean P0.1 between these groups did not achieve statistical significance. Similarly, P0.1/PI,max did not separate the FW and SW patients.…”

Section: Discussioncontrasting

confidence: 36%

“…The predictive value of P0.1 to indicate FW or SW has been questioned by others [26], who were only able to separate FW and SW patients by a difference in hypercapnic augmentation of P0.1. Nevertheless, most studies [22][23][24][25] have demonstrated that neuromuscular output is augmented in ARF and FW patients. It should be emphasized that the present study did not address the utility of these measured variables in predicting weaning outcome, but they were used to assess differences in the physiological characteristics between FW patients and those with ARF.…”

Section: Discussionmentioning

confidence: 99%

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Breathing pattern during acute respiratory failure and recovery

Rosario

Sassoon²,

Chetty³

et al. 1997

Eur Respir J

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The objective of this study was to compare the breathing pattern of patients who failed to wean from mechanical ventilation to the pattern during acute respiratory failure. We hypothesized that a similar breathing pattern occurs under both conditions. Breathing pattern, mouth occlusion pressure (P0.1) and maximum inspiratory pressure (PI,max) were measured in 15 patients during acute respiratory failure, within 24 h of the institution of mechanical ventilation, and in 49 patients during recovery, when they were ready for discontinuation from mechanical ventilation. The following indices were calculated: rapid shallow breathing index (respiratory frequency/tidal volume (f R/VT)); rapid shallow breathing-occlusion pressure index (ROP = P0.1·fR/VT); P0.1/PI,max; and effective inspiratory impedance (P0.1/VT/(inspiratory time (t I)).Patients who failed to wean (n=11) had a similar ROP, fR/VT and P0.1/PI,max to those with acute respiratory failure despite a significantly reduced P0.1/VT/t I, the value of which was comparable to that of patients who weaned successfully (n=38). The PI,max of patients who failed to wean was similar to that of patients who weaned successfully.We conclude that patients who failed to wean had a breathing pattern similar to that during acute respiratory failure, despite a reduced mechanical load on the respiratory muscles and a relatively adequate inspiratory muscle strength. This suggests that strategies that enhance respiratory muscle endurance may facilitate weaning.

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Section: Discussioncontrasting

confidence: 36%

Section: Discussionmentioning

confidence: 99%

Breathing pattern during acute respiratory failure and recovery

Rosario

Sassoon²,

Chetty³

et al. 1997

Eur Respir J

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“…It should be noted, however, that during spontaneous breathing trials COPD patients may exhibit markedly enhanced dynamic hyperinflation (DH) with concomitant decrease in Crs,st. This enhanced DH is closely associated with weaning failure [19,20]. This may explain why Crs,st as well as Crs,eff, measured during mechanical ventilation, are of poor predictive power for weaning outcome (table 4).…”

Section: Discussionmentioning

confidence: 99%

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Alvisi¹,

Volta²,

Er³

et al. 2000

Eur Respir J

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Several threshold values for predicting weaning outcome from mechanical ventilation have been proposed. These values, however, have been obtained in nonhomogeneous patient populations. The aim of the present study was to determine the threshold values in chronic obstructive pulmonary disease (COPD) patients and compare them to those reported for nonhomogeneous patient populations.The initial weaning trial included 81 COPD patients. Fifty-three of them underwent a successful weaning trial, whereas 28 failed it. The latter were enrolled into the present investigation, and were restudied during a subsequent successful trial. The weaning indices used were those reported in the literature.The threshold values obtained were within 10% of those reported for a nonhomogeneous patients population only for tidal volume and effective compliance. The classification error was <20% for maximal inspiratory pressure (MIP), occluded inspiratory pressure swing (DPI)/MIP, rapid and shallow breathing (respiratory frequency/tidal volume), and compliance, rate, oxygenation, pressure index (CROP), whereas the area under the receiver operating characteristic curves was >0.9 only for DPI/MIP and CROP.In conclusion, the threshold values obtained in chronic obstructive pulmonary disease patients who failed the first weaning attempt differed from those previously reported. Although a gold standard weaning index is not available for chronic obstructive pulmonary disease patients, the occluded inspiratory pressure swing/ maximal inspiratory pressure and compliance, rate, oxygenation, pressure index may be candidates for such a role. Eur Respir J 2000; 15: 656±662.

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“…Previous attempts at weaning had resulted in hypercapnic respiratory failure in all patients. Entry into the study occurred when (1) Maximum relaxation rate of the diaphragm during weaning from mechanical ventilation p<0-001) and PDi (p<0001). MRR was not different from the control value by the fourth minute for POES and PDi (fig 1).…”

Section: Normal Subjectsmentioning

confidence: 99%

Maximum relaxation rate of the diaphragm during weaning from mechanical ventilation.

Goldstone

Green

Moxham

1994

Thorax

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Background -The maximum relaxation rate (MRR; percentage fall in pressure/ 10 ms) of oesophageal (POES) and transdiaphragmatic (PDI) pressure slows under conditions of loaded breathing, and has been measured previously in normal subjects. MRR has not been measured in intubated patients weaning from mechanical ventilation. Methods -Five postoperative patients who were expected to wean and nine patients who had previously failed were studied. POES and PDI MRR, peak oesophageal pressure during spontaneous breathing, maximum oesophageal pressure, and the inspiratory duty cycle were measured at rest during mechanical ventilation, in the first two minutes of spontaneous breathing, and after reventilation in those patients who failed, or before extubation in those patients who succeeded. Results -At rest POES MRR in intubated patients had a range of 5-6-11 and PDI MRR 6 9-10 0, with a coefficient of variation of 9-9% and 7-3% respectively. POES and PDI MRR were similar before and after extubation in five postoperative patients, and POES MRR was reflected by endotracheal MRR measured at the airway. In five patients who failed to wean POES and PDI MRR slowed by 47% and 44%, and fully recovered after 10 minutes reventilation. In four patients who were successfully weaned MRR was unchanged during spontaneous breathing. At the time when MRR decreased, the respiratory muscles were heavily loaded in relation to their strength. Conclusions -Weaning failure occurs when the applied load exceeds the capacity of the respiratory muscles, and this is associated with a slowing of respiratory muscle MRR. (Thorax 1994;49:54-60) The ability to sustain ventilation is dependent on central nervous system drive, the strength of the respiratory muscles, and the load applied to them. Available data suggest that central drive to the respiratory muscles is elevated in ventilatory failure,' and in patients who are difficult to wean those who eventually fail have a greater drive than patients who succeed.2 Attention has therefore focused on respiratory muscle function where investigators have sought to establish the importance of respiratory muscle fatigue during weaning.Respiratory muscle fatigue has been defined as an acute failure to generate the required or expected force or velocity which is reversible with rest.3 It can be induced in normal subjects during loaded breathing through an inspiratory resistance.4 The degree and duration of loading needed to produce fatigue has been extensively investigated5 and can be numerically quantified to predict when force loss will occur.' By their nature, these studies have focused on the end point of loaded breathing, usually failure to achieve target pressures. Clinically, most attention is directed at observing the performance of patients at the beginning of a trial of spontaneous breathing in order to predict eventual weaning failure.Under conditions of heavy load the rate of contraction and relaxation of muscle slows. The relaxation rate of the respiratory muscles has been measured from t...

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Tracheal Occlusion Pressure: A Simple Index to Monitor Respiratory Muscle Fatigue during Acute Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease

Abstract: Extubation should not be done in patients with respiratory muscle fatigue despite improvement in arterial blood gases and clinical status; and P0.1 provides a valid and simple index to assess the likelihood of respiratory muscle fatigue.

Cited by 119 publications

References 18 publications

Breathing pattern during acute respiratory failure and recovery

Breathing pattern during acute respiratory failure and recovery

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Maximum relaxation rate of the diaphragm during weaning from mechanical ventilation.

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