Use of airway pressure-based indices to detect high and low inspiratory effort during pressure support ventilation: a diagnostic accuracy study

Yang, YL; Liu, Y; Gao, R; Song, DJ; Zhou, YM; Miao, MY; Chen, W; Wang, SP; Wang, YF; Zhang, L; Zhou, JX

doi:10.1186/s13613-023-01209-7

Respiratory failure & ventilation

Use of airway pressure-based indices to detect high and low inspiratory effort during pressure support ventilation: a diagnostic accuracy study

Ann Intensive CarePublished 13 Nov 2023Diagnostic accuracy study

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Authors' conclusion

By performing simple airway occlusion maneuvers, the Paw-based indices could be reliably used to detect low inspiratory efforts.

Study context

Population: Adults with acute respiratory failure undergoing pressure support (PS) ventilation, downward PS titration 20 to 2 cmH2O246 PS levels tested
Participants: 28 adults

Comparison: Paw-based indices vs oesophageal pressure-derived Pmus and PTPmus/min
Outcome: Accuracy of Paw-based indices to detect high (Pmus > 10 cmH2O or PTPmus/min > 200 cmH2O s min-1) and low (Pmus < 5 cmH2O or PTPmus/min < 50 cmH2O s min-1) inspiratory effort

Methodological detailsprospective, multicentre (four ICUs, two academic hospitals)

Prospective
Multicentre (four ICUs, two academic hospitals)

Performance

As reported in the abstract

Detection of low inspiratory effort (Pmus and PTPmus/min criteria)

Low effort diagnosed by Pmus criterion, PS levels: 145 (59.0%)
Low effort diagnosed by PTPmus/min criterion, PS levels: 136 (55.3%)
ROC area of the three indices, both criteria: 0.87 to 0.95
Sensitivity: 0.83-0.96
Specificity: 0.74-0.88
PPV: 0.80-0.91
NPV: 0.78-0.94

Further findings

Detection of high inspiratory effort (Pmus and PTPmus/min criteria)

High effort diagnosed by Pmus criterion, support levels: 34 (13.8%)
High effort diagnosed by PTPmus/min criterion, support levels: 17 (6.9%)
ROC area of the three indices, both criteria: 0.93-0.95
Sensitivity: 0.80-1.00
NPV: 0.97-1.00
PPV (low): 0.23-0.64

Ranges across the three indices and two criteria

Reference

Authors: Yang YL, Liu Y, Gao R, Song DJ, Zhou YM, Miao MY, et al.
All 11 authors
Yang YL, Liu Y, Gao R, Song DJ, Zhou YM, Miao MY, Chen W, Wang SP, Wang YF, Zhang L, Zhou JX
Journal: Annals of Intensive Care
Published: 13 Nov 2023
DOI: 10.1186/s13613-023-01209-7
PubMed: 37955842

Topic: Respiratory failure & ventilation

Comparison

Paw-based indices (P0.1, ∆Pocc, pressure muscle index (PMI)) vs oesophageal pressure-derived Pmus and PTPmus/min (reference standard)

Diagnostic definitions

P0.1: negative Paw generated during the first 100 ms of an end-expiratory airway occlusion
∆Pocc: maximal negative swing of Paw during end-expiratory airway occlusion
PMI: change in plateau from peak Paw after end-inspiratory airway occlusion (pressure muscle index)

Key notes

Ranges across the three indices and two criteria

Original publication

Use of airway pressure-based indices to detect high and low inspiratory effort during pressure support ventilation: a diagnostic accuracy study. Ann Intensive Care. Published 13 November 2023. doi:10.1186/s13613-023-01209-7

Read the original article ↗

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