Respiratory failure & ventilation
Gastric Pressure Monitoring Unveils Abnormal Patient–Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study
Authors' conclusion
Active expiration can impair patient-ventilator interaction in critically ill patients.
Study context
- Population
- Invasively ventilated patients on assisted mechanical ventilation with spontaneous breathing activity and esophageal and gastric pressure monitored for clinical purposes
- Participants
- 76 participants
- Exposure
- Active expiration vs no active expiration
- Active expirationn = 58
- Outcome
- Abnormal patient-ventilator interaction related to active expiration (waveform analysis of Peso, gastric pressure, diaphragmatic pressure, flow and Paw)
Main finding
As reported in the abstract
Active expiration and associated abnormal patient-ventilator interaction
Active expiration
3.4
58 of 58
- Patients with active expiration presenting events associated with expiratory muscle activity (ineffective-effort-like and autotriggering-like distortions, multiple triggering, prolonged cycles with biphasic inspiratory flow, breathing exclusively by expiratory muscle relaxation)
- 23
- Prolonged cycles: median increase in mechanical inflation time (IQR)
- 54% (44 to 70%)
- Prolonged cycles: median increase in tidal volume (IQR)
- 25% (8 to 35%)
Observational data: associations, not effects.
Further findings
Median, cmH2O/sec
| Outcome | Active expiration | No active expiration | P value |
|---|---|---|---|
| Respiratory drive (rate of inspiratory Peso decrease, dPeso/dt)Significantly higher with active expiration | 12.7 (IQR 9.0–18.5) | 9.2 (IQR 6.8–14.2) | P < 0.05 |
Original publication
Gastric Pressure Monitoring Unveils Abnormal Patient–Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study. Anesthesiology. Published 16 May 2024. doi:10.
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