Respiratory failure & ventilation
Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study
Authors' conclusion
In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics.
Study context
- Population
- Mechanically ventilated patients with AE-ILD-UIP and severe acute respiratory failure vs primary ARDS
- Participants
- 10 vs 10
- Comparison
- AE-ILD-UIP vs primary ARDS at three PEEP levels
- AE-ILD-UIPn = 10
- ARDSn = 10reference
- Outcome
- Partitioned lung and chest wall mechanics (PL,EE, EL, ΔPL) at ZEEP, PEEPLOW (4-8 cmH2O) and PEEPTITRATED (positive PL,EE)
Methodological detailsmatched 1:1 (BMI and PaO2/FiO2 ratio)
- Matched 1:1 (BMI and PaO2/FiO2 ratio)
Main finding
As reported in the abstract
Lung mechanics in AE-ILD-UIP
| Group | Value | Elastance (EL) at ZEEP | PL,EE at PEEPTITRATED | EL at PEEPTITRATED |
|---|---|---|---|---|
| AE-ILD-UIP | median - 4.3 (IQR - 7.6- - 2.3) cmH2O | 44 [40-51] cmH2O/L | 0.8 [0.3-1.5] cmH2O | 49 [43-59] |
AE-ILD-UIP
Valuemedian - 4.3 (IQR - 7.6- - 2.3) cmH2O
Elastance (EL) at ZEEP44 [40-51] cmH2O/L
PL,EE at PEEPTITRATED0.8 [0.3-1.5] cmH2O
EL at PEEPTITRATED49 [43-59]
- PL,EE at ZEEP (median, AE-ILD-UIP)
- - 4.3 [- 7.6- - 2.3] cmH2O
- At PEEPLOW, PL,EE remained negative; EL unchanged vs ZEEP
- P = 0.995
- At PEEPTITRATED, PL,EE and EL increased vs ZEEP and PEEPLOW
- P = 0.004 and p < 0.001
- ΔPL decreased at PEEPLOW
- P = 0.018
- ΔPL increased at PEEPTITRATED
- P = 0.003
Original publication
Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study. Crit Care. Published 18 October 2023. doi:10.
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