Respiratory failure & ventilation
Driving pressure of respiratory system and lung stress in mechanically ventilated patients with active breathing
Authors' conclusion
In patients with ARDS ventilated with PAV+, injurious tidal lung stress and effort were infrequent. In the presence of expiratory muscle activity, ΔPrs underestimated ΔPlung.
Study context
- Population
- Patients with acute respiratory distress syndrome (ARDS) switched from control mechanical ventilation to proportional assist ventilation (PAV+)22 with esophageal and gastric catheters
- Participants
- 31 patients
- Exposure
- Group A vs Group B
- Group An = 17
- Group Bn = 14
- Outcome
- Prevalence of elevated ΔPlung (≥ 12 cmH2O)
- Follow-up
- Over a maximum of 24 h
Methodological details7-breath moving average, decile analysis by lung elastance
- 7-breath moving average
- Decile analysis by lung elastance
Main finding
As reported in the abstract
ΔPlung ≥ 12 cmH2O (% of measurements)
ΔPlung ≥ 12 cmH2O infrequently observed (% of measurements, 44,836 occluded breaths)
0.0%
0.0–16.9%
Observational data: associations, not effects.
Further findings
| Outcome | Group A | Group B |
|---|---|---|
| ΔPrs predicting ΔPlung ≥ 12 cmH2O (AUC)In Group B, no predictive capacity | ||
| AUC | 0.91 (0.86-0.95), P < 0.001 | 0.65 (0.52-0.78), P > 0.05 |
- ΔPrs predicting ΔPlung ≥ 12 cmH2O (AUC) — AUC, all patients
- 0.87 (95% CI 0.82-0.92, P < 0.001)
ΔPrs-ΔPlung relationship
- End-expiratory lung volume decrease due to active expiration associated with underestimation of ΔPlung by ΔPrs (negative linear relationship between PLEE and ΔPlung/ΔPrs)
- As Elung increased, ΔPlung increased mainly due to PLEI increase in Group A and PLEE decrease in Group B
Plungsw and effort indices
- Most of the time within safe range
Original publication
Driving pressure of respiratory system and lung stress in mechanically ventilated patients with active breathing. Crit Care. Published 12 January 2024. doi:10.
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