Respiratory failure & ventilation
Airway Occlusions to Measure Inspiratory Effort, Respiratory Drive, and Lung Mechanics During Noninvasive Ventilation
Authors' conclusion
During NIV, Pocc-derived parameters provide non-invasive estimates of inspiratory effort, lung stress and mechanics, whereas ventilator P0.1 and plateau pressure are less reliable.
Study context
- Population
- Hypoxemic patients receiving noninvasive ventilation (NIV) after extubation20 derivation, 40 validation
- Participants
- 60 patients
- Comparison
- Occlusion-derived estimates vs esophageal manometry reference, oro-nasal vs full-face mask
- Outcome
- Agreement of predicted with observed ΔPes and ΔPL,dyn
Methodological detailsmulticentre, randomised crossover of interfaces, cross-validation
- Multicentre
- Randomised crossover of interfaces
- Cross-validation
Main finding
As reported in the abstract
| Group | Mean K | ΔPes bias (cm H2O) | ΔPes 95% limits of agreement | ΔPL,dyn bias | ΔPL,dyn 95% limits of agreement | AUC for ΔPes ≤ −10 cm H2O | ΔPes bias |
|---|---|---|---|---|---|---|---|
| Oro-nasal | 0.71 | −0.41 | −2.3 to 1.5 | 0.03 | −2.9 to 2.9 | 0.98 | |
| Full-face | 0.80 | −2.9 to 3.1 | −0.04 | −4.3 to 4.2 | 0.97 | 0.09 |
Mean K
Oro-nasal0.71
Full-face0.80
ΔPes bias (cm H2O)
Oro-nasal−0.41
Full-face— not stated in the abstract
ΔPes 95% limits of agreement
Oro-nasal−2.3 to 1.5
Full-face−2.9 to 3.1
ΔPL,dyn bias
Oro-nasal0.03
Full-face−0.04
ΔPL,dyn 95% limits of agreement
Oro-nasal−2.9 to 2.9
Full-face−4.3 to 4.2
AUC for ΔPes ≤ −10 cm H2O
Oro-nasal0.98
Full-face0.97
ΔPes bias
Oro-nasal— not stated in the abstract
Full-face0.09
Further findings
Plateau pressure unstable
| Outcome | Oro-nasal | Full-face |
|---|---|---|
| Ventilator-derived P0.1 for respiratory drive | ||
| Threshold for high drive (specificity >90%) | >2.7 cm H2O | >3 cm H2O |
Ventilator-derived P0.1 for respiratory drive
- P0.1 did not precisely quantify respiratory drive
Re-intubation
- More negative predicted ΔPes, higher predicted ΔPL,dyn and lower predicted lung compliance associated with subsequent re-intubation
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Airway Occlusions to Measure Inspiratory Effort, Respiratory Drive, and Lung Mechanics During Noninvasive Ventilation. Am J Respir Crit Care Med. Published 13 June 2026. doi:10.
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