Respiratory failure & ventilation
Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort in Mechanically Ventilated Critically Ill Patients
Authors' conclusion
Pocc and P0.1 correlate with lung stress and diaphragm effort in the preceding hour. Diagnostic performance of Pocc and P0.1 to detect extremes in these parameters is reasonable to excellent. Pocc is more accurate in detecting high diaphragm effort.
Study context
- Population
- Mechanically ventilated critically ill patients with double-balloon nasogastric cathetersvalidation cohort n = 13
- Participants
- 38 participants
- Comparison
- Pocc vs P0.1
- Outcome
- AUC of Pocc and P0.1 to identify extremes of lung stress (change in transpulmonary pressure > 20 cm H2O) and diaphragm effort (change in transdiaphragmatic pressure < 3 cm H2O and >12 cm H2O) in the preceding hour
Methodological detailsderivation cohort, external validation cohort
- Derivation cohort
- External validation cohort
Performance
As reported in the abstract
Discriminative performance for extremes of lung stress (change in transpulmonary pressure > 20 cm H2O) and diaphragm effort (change in transdiaphragmatic pressure < 3 cm H2O and >12 cm H2O) in the preceding hour
| Test or model | AUC high lung stress | AUC low diaphragm effort | AUC high diaphragm effort | R2 vs change in transpulmonary pressure | R2 vs change in transdiaphragmatic pressure |
|---|---|---|---|---|---|
| Pocc | 0.90 (0.86 to 0.94) | 0.97 (0.87 to 1.00) | 0.86 (0.81 to 0.91) | 0.62 | 0.53 |
| P0.1 | 0.88 (0.84 to 0.92) | 0.93 (0.81 to 0.99) | 0.73 (0.66 to 0.79) | 0.51 | 0.22 |
AUC high lung stress
Pocc0.90 (0.86 to 0.94)
P0.10.88 (0.84 to 0.92)
AUC low diaphragm effort
Pocc0.97 (0.87 to 1.00)
P0.10.93 (0.81 to 0.99)
AUC high diaphragm effort
Pocc0.86 (0.81 to 0.91)
P0.10.73 (0.66 to 0.79)
R2 vs change in transpulmonary pressure
Pocc0.62
P0.10.51
R2 vs change in transdiaphragmatic pressure
Pocc0.53
P0.10.22
Further findings
| Outcome | Pocc | P0.1 |
|---|---|---|
| Correlation with change in transpulmonary and transdiaphragmatic pressure | ||
| R2 transpulmonary pressure | 0.62 | 0.51 |
| R2 transdiaphragmatic pressure | 0.53 | 0.22 |
Performance in external validation dataset
- Performance was similar in the external dataset
Original publication
Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort in Mechanically Ventilated Critically Ill Patients. Anesthesiology. Published 15 December 2022. doi:10.
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