Respiratory failure & ventilation
Tidal lung hysteresis to interpret PEEP-induced changes in compliance in ARDS patients
Authors' conclusion
Assessment of tidal hysteresis improves the interpretation of decremental PEEP trials and may help limiting tidal recruitment and energy dissipated into the respiratory system during mechanical ventilation of ARDS patients.
Study context
- Population
- COVID-19 moderate to severe ARDS patients
- Participants
- 38 participants
- Comparison
- PEEP selected by combined approach vs best compliance approach
- Outcome
- Tidal recruitment patterns by changes of tidal hysteresis
Methodological detailsdecremental PEEP trial, low-flow inflation-deflation manoeuvre
- Decremental PEEP trial
- Low-flow inflation-deflation manoeuvre
Main finding
As reported in the abstract
- Consistently high tidal-recruitment
- 10 (26%)
- Consistently low tidal-recruitment
- 12 (32%)
- Biphasic pattern (low to high tidal-recruitment below a certain PEEP)
- 16 (42%)
- Compliance increased after PEEP step decreases
- 82%
- Compliance increase associated with large increase of tidal hysteresis
- 44%
- Agreement between best compliance and combined approaches (poor), K
- 0.024
Further findings
Tidal hysteresis
P < 0.001
Dissipated energy per breath
P < 0.001
Tidal hysteresis ≥ 100 mL predicting tidal recruitment at next PEEP step reduction
- AUC (p < 0.001)
- 0.97
PEEP suggested by combined approach
- Increase PEEP in high tidal-recruiters, mainly keep PEEP constant in biphasic pattern, decrease PEEP in low tidal-recruiters
Original publication
Tidal lung hysteresis to interpret PEEP-induced changes in compliance in ARDS patients. Crit Care. Published 13 June 2023. doi:10.
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