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A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation
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A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation
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Journal Article
A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation
2019
Overview
Background
Excessive respiratory muscle effort during mechanical ventilation may cause patient self-inflicted lung injury and load-induced diaphragm myotrauma, but there are no non-invasive methods to reliably detect elevated transpulmonary driving pressure and elevated respiratory muscle effort during assisted ventilation. We hypothesized that the swing in airway pressure generated by respiratory muscle effort under assisted ventilation when the airway is briefly occluded (Δ
P
occ
) could be used as a highly feasible non-invasive technique to screen for these conditions.
Methods
Respiratory muscle pressure (
P
mus
), dynamic transpulmonary driving pressure (Δ
P
L,dyn
, the difference between peak and end-expiratory transpulmonary pressure), and Δ
P
occ
were measured daily in mechanically ventilated patients in two ICUs in Toronto, Canada. A conversion factor to predict Δ
P
L,dyn
and
P
mus
from Δ
P
occ
was derived and validated using cross-validation. External validity was assessed in an independent cohort (Nanjing, China).
Results
Fifty-two daily recordings were collected in 16 patients. In this sample,
P
mus
and Δ
P
L
were frequently excessively high:
P
mus
exceeded 10 cm H
2
O on 84% of study days and Δ
P
L,dyn
exceeded 15 cm H
2
O on 53% of study days. Δ
P
occ
measurements accurately detected
P
mus
> 10 cm H
2
O (AUROC 0.92, 95% CI 0.83–0.97) and Δ
P
L,dyn
> 15 cm H
2
O (AUROC 0.93, 95% CI 0.86–0.99). In the external validation cohort (
n
= 12), estimating
P
mus
and Δ
P
L,dyn
from Δ
P
occ
measurements detected excessively high
P
mus
and Δ
P
L,dyn
with similar accuracy (AUROC ≥ 0.94).
Conclusions
Measuring Δ
P
occ
enables accurate non-invasive detection of elevated respiratory muscle pressure and transpulmonary driving pressure. Excessive respiratory effort and transpulmonary driving pressure may be frequent in spontaneously breathing ventilated patients.
Publisher
BioMed Central,BioMed Central Ltd,BMC
Subject
/ Acute Lung Injury - physiopathology
/ Acute Lung Injury - prevention & control
/ Adult respiratory distress syndrome
/ Aged
/ Female
/ Humans
/ Male
/ Medicine
/ Methods
/ Monitoring, Physiologic - methods
/ Noninvasive Ventilation - methods
/ Pressure
/ Respiration, Artificial - methods
/ Respiratory Muscles - injuries
/ Respiratory Muscles - physiopathology
/ Weights and Measures - instrumentation
