Respiratory failure & ventilation
Inter-lung asymmetrical airway closure cause insufflation delay between lungs in acute hypoxemic respiratory failure
Authors' conclusion
In asymmetrical airway closure, titrating PEEP can minimize inter-lung insufflation delay and can be monitored by EIT.
Study context
- Population
- Patients with acute hypoxemic respiratory failure and airway closure (22 with ARDS)22 with ARDS
- Participants
- 23 patients
- Exposure
- Asymmetrical vs no asymmetrical airway closure
- With asymmetryn = 9
- Outcome
- Relation between AOP asymmetry and inter-lung insufflation delay at different PEEP levels
Main finding
As reported in the abstract
Inter-lung inflation delay during low flow inflation
P < 0.0001
- Delay correlated to the difference of airway opening pressure (AOP) between the 2 lungs, Spearman R2
- 0.800
Observational data: associations, not effects.
Further findings
Inter-lung insufflation delay during tidal ventilation
P = 0.019
Inter-lung inflation delay vs difference of AOP between the 2 lungs (correlation)
- Spearman R2
- 0.800
- p < 0.0001
AOP in patients with asymmetrical airway closure
- AOP in the sicker lung
- 10 [6-13] cmH20
- AOP in the healthier lung
- 5 [3-9, ] cmH20
PEEP set at the crossing point of a decremental Electrical Impedance Tomography (EIT)-based PEEP trial
- Decreased the inter-lung insufflation delay
Insufflation delay during pressure support
- Still measurable; reduced by increasing PEEP from 5 to 10 cmH2O in asymmetrical lung injury
Original publication
Inter-lung asymmetrical airway closure cause insufflation delay between lungs in acute hypoxemic respiratory failure. Ann Intensive Care. Published 23 October 2024. doi:10.
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