Respiratory failure & ventilation
Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure
Authors' conclusion
Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, and are associated with subsequent worsening oxygenation and lung compliance.
Study context
- Population
- Patients with acute hypoxemic respiratory failure with esophageal pressure recordings
- Participants
- 60 patients · 15 centres
- Exposure
- Volume-control vs pressure-targeted ventilation modes
- Outcome
- Change per 1 cm H2O increase in Pmus
Methodological detailsinternational, multicentre, mixed models
- International
- Multicentre
- Mixed models
Main finding
As reported in the abstract
Increase in driving transalveolar pressure, median (95% CI 0.27 to 0.29) cm H2O
0.28
Decrease in alveolar pressure, median (95% CI 0.24 to 0.6) cm H2O; P < 0.001
0.25
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Pmus-by-mode interactionInteraction P | P < 0.001 |
- Pmus-by-mode interaction: lesser increases in stress and strain surrogates but more drop in alveolar pressure
Breath stacking
- Infrequent; associated with higher stress
Subsequent oxygenation and lung compliance
- Lower inspiratory alveolar pressure relative to positive end-expiratory pressure (PEEP) associated with worsening oxygenation
- P = 0.04
- Higher stress associated with worsening lung compliance
- P = 0.023
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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