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Ruiz-Botella M, Manrique S, Gomez J, Bodí M. Advancing ICU patient care with a Real-Time predictive model for mechanical Power to mitigate VILI. Int J Med Inform 2024; 189:105511. [PMID: 38851133 DOI: 10.1016/j.ijmedinf.2024.105511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Invasive Mechanical Ventilation (IMV) in Intensive Care Units (ICU) significantly increases the risk of Ventilator-Induced Lung Injury (VILI), necessitating careful management of mechanical power (MP). This study aims to develop a real-time predictive model of MP utilizing Artificial Intelligence to mitigate VILI. METHODOLOGY A retrospective observational study was conducted, extracting patient data from Clinical Information Systems from 2018 to 2022. Patients over 18 years old with more than 6 h of IMV were selected. Continuous data on IMV variables, laboratory data, monitoring, procedures, demographic data, type of admission, reason for admission, and APACHE II at admission were extracted. The variables with the highest correlation to MP were used for prediction and IMV data was grouped in 15-minute intervals using the mean. A mixed neural network model was developed to forecast MP 15 min in advance, using IMV data from 6 h before the prediction and current patient status. The model's ability to predict future MP was analyzed and compared to a baseline model predicting the future value of MP as equal to the current value. RESULTS The cohort consisted of 1967 patients after applying inclusion criteria, with a median age of 63 years and 66.9 % male. The deep learning model achieved a mean squared error of 2.79 in the test set, indicating a 20 % improvement over the baseline model. It demonstrated high accuracy (94 %) in predicting whether MP would exceed a critical threshold of 18 J/min, which correlates with increased mortality. The integration of this model into a web platform allows clinicians real-time access to MP predictions, facilitating timely adjustments to ventilation settings. CONCLUSIONS The study successfully developed and integrated in clinical practice a predictive model for MP. This model will assist clinicians allowing for the adjustment of ventilatory parameters before lung damage occurs.
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Affiliation(s)
- M Ruiz-Botella
- Departament of Chemical Engineering, Universitat Rovira I Virgili, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain.
| | - S Manrique
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - J Gomez
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - M Bodí
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Spain
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Abram J, Martini J, Spraider P, Putzer G, Ranalter M, Wagner J, Glodny B, Hell T, Barnes T, Enk D. Individualised flow-controlled versus pressure-controlled ventilation in a porcine oleic acid-induced acute respiratory distress syndrome model. Eur J Anaesthesiol 2023; 40:511-520. [PMID: 36749046 PMCID: PMC10256303 DOI: 10.1097/eja.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A continuous gas flow provided by flow-controlled ventilation (FCV) facilitates accurate dynamic compliance measurement and allows the clinician to individually optimise positive end-expiratory and peak pressure settings accordingly. OBJECTIVE The aim of this study was to compare the efficiency of gas exchange and impact on haemodynamics between individualised FCV and pressure-controlled ventilation (PCV) in a porcine model of oleic acid-induced acute respiratory distress syndrome (ARDS). DESIGN Randomised controlled interventional trial conducted on 16 pigs. SETTING Animal operating facility at the Medical University Innsbruck. INTERVENTIONS ARDS was induced in lung healthy pigs by intravenous infusion of oleic acid until moderate-to-severe ARDS at a stable Horowitz quotient (PaO 2 FiO 2-1 ) of 80 to 120 over a period of 30 min was obtained. Ventilation was then either performed with individualised FCV ( n = 8) established by compliance-guided pressure titration or PCV ( n = 8) with compliance-guided titration of the positive end-expiratory pressure and peak pressure set to achieve a tidal volume of 6 ml kg -1 over a period of 2 h. MAIN OUTCOME MEASURES Gas exchange parameters were assessed by the PaO 2 FiO 2-1 quotient and CO 2 removal by the PaCO 2 value in relation to required respiratory minute volume. Required catecholamine support for haemodynamic stabilisation was measured. RESULTS The FCV group showed significantly improved oxygenation [149.2 vs. 110.4, median difference (MD) 38.7 (8.0 to 69.5) PaO 2 FiO 2-1 ; P = 0.027] and CO 2 removal [PaCO 2 7.25 vs. 9.05, MD -1.8 (-2.87 to -0.72) kPa; P = 0.006] at a significantly lower respiratory minute volume [8.4 vs. 11.9, MD -3.6 (-5.6 to -1.5) l min -1 ; P = 0.005] compared with PCV. In addition, in FCV-pigs, haemodynamic stabilisation occurred with a significant reduction of required catecholamine support [norepinephrine 0.26 vs. 0.86, MD -0.61 (-1.12 to -0.09) μg kg -1 min -1 ; P = 0.037] during 2 ventilation hours. CONCLUSION In this oleic acid-induced porcine ARDS model, individualised FCV significantly improved gas exchange and haemodynamic stability compared with PCV. TRIAL REGISTRATION Protocol no.: BMBWF-66.011/0105-V/3b/2019).
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Affiliation(s)
- Julia Abram
- From the Department of Anaesthesia and Intensive Care Medicine (JA, JM, PS, GP, MR, JW), Department of Radiology, Medical University of Innsbruck (BG), Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria (TH), University of Greenwich, London, UK (TB), Faculty of Medicine, University of Münster, Münster, Germany (DE)
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Enk D, Spraider P, Abram J, Barnes T. Commentary: Flow-controlled ventilation maintains gas exchange and lung aeration in a pediatric model of healthy and injured lungs: a randomized cross-over experimental study. Front Pediatr 2023; 11:1122434. [PMID: 37334222 PMCID: PMC10275487 DOI: 10.3389/fped.2023.1122434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Dietmar Enk
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Patrick Spraider
- Department of Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Abram
- Department of Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Tom Barnes
- Faculty of Engineering and Science, University of Greenwich, London, United Kingdom
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Schranc Á, Diaper J, Südy R, Peták F, Habre W, Albu G. Lung recruitment by continuous negative extra-thoracic pressure support following one-lung ventilation: an experimental study. Front Physiol 2023; 14:1160731. [PMID: 37256073 PMCID: PMC10225513 DOI: 10.3389/fphys.2023.1160731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023] Open
Abstract
Lung recruitment maneuvers following one-lung ventilation (OLV) increase the risk for the development of acute lung injury. The application of continuous negative extrathoracic pressure (CNEP) is gaining interest both in intubated and non-intubated patients. However, there is still a lack of knowledge on the ability of CNEP support to recruit whole lung atelectasis following OLV. We investigated the effects of CNEP following OLV on lung expansion, gas exchange, and hemodynamics. Ten pigs were anesthetized and mechanically ventilated with pressure-regulated volume control mode (PRVC; FiO2: 0.5, Fr: 30-35/min, VT: 7 mL/kg, PEEP: 5 cmH2O) for 1 hour, then baseline (BL) data for gas exchange (arterial partial pressure of oxygen, PaO2; and carbon dioxide, PaCO2), ventilation and hemodynamical parameters and lung aeration by electrical impedance tomography were recorded. Subsequently, an endobronchial blocker was inserted, and OLV was applied with a reduced VT of 5 mL/kg. Following a new set of measurements after 1 h of OLV, two-lung ventilation was re-established, combining PRVC (VT: 7 mL/kg) and CNEP (-15 cmH2O) without any hyperinflation maneuver and data collection was then repeated at 5 min and 1 h. Compared to OLV, significant increases in PaO2 (154.1 ± 13.3 vs. 173.8 ± 22.1) and decreases in PaCO2 (52.6 ± 11.7 vs. 40.3 ± 4.5 mmHg, p < 0.05 for both) were observed 5 minutes following initiation of CNEP, and these benefits in gas exchange remained after an hour of CNEP. Gradual improvements in lung aeration in the non-collapsed lung were also detected by electrical impedance tomography (p < 0.05) after 5 and 60 min of CNEP. Hemodynamics and ventilation parameters remained stable under CNEP. Application of CNEP in the presence of whole lung atelectasis proved to be efficient in improving gas exchange via recruiting the lung without excessive airway pressures. These benefits of combined CNEP and positive pressure ventilation may have particular value in relieving atelectasis in the postoperative period of surgical procedures requiring OLV.
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Affiliation(s)
- Álmos Schranc
- Unit for Anesthesiological Investigations, Department of Anesthesiology Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - John Diaper
- Unit for Anesthesiological Investigations, Department of Anesthesiology Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Roberta Südy
- Unit for Anesthesiological Investigations, Department of Anesthesiology Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Ferenc Peták
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Walid Habre
- Unit for Anesthesiological Investigations, Department of Anesthesiology Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Gergely Albu
- Unit for Anesthesiological Investigations, Department of Anesthesiology Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
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Schranc Á, Diaper J, Südy R, Fodor GH, Habre W, Albu G. Benefit of Flow-Controlled Over Pressure-Regulated Volume Control Mode During One-Lung Ventilation: A Randomized Experimental Crossover Study. Anesth Analg 2023; 136:605-612. [PMID: 36729097 DOI: 10.1213/ane.0000000000006322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Application of a ventilation modality that ensures adequate gas exchange during one-lung ventilation (OLV) without inducing lung injury is of paramount importance. Due to its beneficial effects on respiratory mechanics and gas exchange, flow-controlled ventilation (FCV) may be considered as a protective alternative mode of traditional pressure- or volume-controlled ventilation during OLV. We investigated whether this new modality provides benefits compared with conventional ventilation modality for OLV. METHODS Ten pigs were anaesthetized and randomly assigned in a crossover design to be ventilated with FCV or pressure-regulated volume control (PRVC) ventilation. Arterial partial pressure of oxygen (Pa o2 ), carbon dioxide (Pa co2 ), ventilation and hemodynamical parameters, and lung aeration measured by electrical impedance tomography were assessed at baseline and 1 hour after the application of each modality during OLV using an endobronchial blocker. RESULTS Compared to PRVC, FCV resulted in increased Pa o2 (153.7 ± 12.7 vs 169.9 ± 15.0 mm Hg; P = .002) and decreased Pa co2 (53.0 ± 11.0 vs 43.2 ± 6.0 mm Hg; P < .001) during OLV, with lower respiratory elastance (103.7 ± 9.5 vs 77.2 ± 10.5 cm H 2 O/L; P < .001) and peak inspiratory pressure values (27.4 ± 1.9 vs 22.0 ± 2.3 cm H 2 O; P < .001). No differences in lung aeration or hemodynamics could be detected between the 2 ventilation modalities. CONCLUSIONS The application of FCV in OLV led to improvement in gas exchange and respiratory elastance with lower ventilatory pressures. Our findings suggest that FCV may offer an optimal, protective ventilation modality for OLV.
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Affiliation(s)
- Álmos Schranc
- From the Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - John Diaper
- From the Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Roberta Südy
- From the Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Walid Habre
- From the Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
- Pediatric Anesthesia Unit, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Gergely Albu
- From the Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Franck CL, Franck GM. Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2. Rev Bras Ter Intensiva 2022; 34:212-219. [PMID: 35946651 DOI: 10.5935/0103-507x.20220018-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To analyze the influence of mechanical power and its components on mechanical ventilation for patients infected with SARS-CoV-2; identify the values of the mechanical ventilation components and verify their correlations with each other and with the mechanical power and effects on the result of the Gattinoni-S and Giosa formulas. METHODS This was an observational, longitudinal, analytical and quantitative study of respirator and mechanical power parameters in patients with SARS-CoV-2. RESULTS The mean mechanical power was 26.9J/minute (Gattinoni-S) and 30.3 J/minute (Giosa). The driving pressure was 14.4cmH2O, the plateau pressure was 26.5cmH2O, the positive end-expiratory pressure was 12.1cmH2O, the elastance was 40.6cmH2O/L, the tidal volume was 0.36L, and the respiratory rate was 32 breaths/minute. The correlation between the Gattinoni and Giosa formulas was 0.98, with a bias of -3.4J/minute and a difference in the correlation of the resistance pressure of 0.39 (Gattinoni) and 0.24 (Giosa). Among the components, the correlations between elastance and driving pressure (0.88), positive end-expiratory pressure (-0.54) and tidal volume (-0.44) stood out. CONCLUSION In the analysis of mechanical ventilation for patients with SARS-CoV-2, it was found that the correlations of its components with mechanical power influenced its high momentary values and and that the correlations of its components with each other influenced their behavior throughout the study period. Because they have specific effects on the Gatinnoni-S and Giosa formulas, the mechanical ventilation components influenced their calculations and caused divergence in the mechanical power values.
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Xie Y, Zheng H, Mou Z, Wang Y, Li X. High Expression of CXCL10/CXCR3 in Ventilator-Induced Lung Injury Caused by High Mechanical Power. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6803154. [PMID: 35036436 PMCID: PMC8759875 DOI: 10.1155/2022/6803154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). However, the effect of ventilator-induced lung injury (VILI) in patients suffering from acute respiratory distress syndrome (ARDS) is still unknown. Our previous studies revealed that CXCL10 may be a potential biomarker of lung injury in ARDS. Therefore, the aim of this study was to compare the lung injury of rats and patients under different MP conditions to explore the involvement of CXCL10 and its receptor CXCR3 in VILI. METHODS Patients were divided into the high mechanical power group (HMPp group) and low mechanical power group (LMPp group), while rats were assigned to the high mechanical power group (HMPr group), medium mechanical power group (MMPr group), and low mechanical power group (LMPr group). CXCL10 and CXCR3 plasma content in ARDS patients and rats under ventilation at different MP was measured, as well as their protein and mRNA expression in rat lungs. RESULTS CXCL10 and CXCR3 content in the plasma of ARDS patients in the HMPp was significantly higher than that in the LMPp. The increase of MP during mechanical ventilation in the rats gradually increased lung damage, and CXCL10 and CXCR3 levels in rat plasma gradually increased with the increase of MP. CXCL10 and CXCR3 protein and mRNA expression in the HMPr group and MMPr group was significantly higher than that in the LMPr group (P < 0.05). More mast cells were present in the trachea, bronchus, blood vessels, and lymphatic system in the rat lungs of the HMPr group, and the number of mast cells in the HMPr group (13.32 ± 3.27) was significantly higher than that in the LMPr group (3.25 ± 0.29) (P < 0.05). CONCLUSION The higher the MP, the more severe the lung injury, and the higher the CXCL10/CXCR3 expression. Therefore, CXCL10/CXCR3 might participate in VILI by mediating mast cell chemotaxis.
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Affiliation(s)
- Yongpeng Xie
- Department of Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Hui Zheng
- Department of Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Zhifang Mou
- Department of Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Yanli Wang
- Department of Emergency Medicine, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaomin Li
- Department of Emergency Medicine, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
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Correlation Analysis between Mechanical Power and Lung Ultrasound Score and Their Evaluation of Severity and Prognosis in ARDS Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4156162. [PMID: 34513990 PMCID: PMC8429004 DOI: 10.1155/2021/4156162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Methods A total of 121 patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from June 2017 to April 2020 and treated with invasive mechanical ventilation were sequentially included in this study. Their general information was collected, and MP was recorded at 0 h, 24 h, 48 h, and 72 h after admission to the ICU. Professionally trained researchers performed the LUS assessments. Patients were divided into the death and survival groups according to their 28-day prognosis. The trend of MP and LUS at the four time points was analyzed. A receiver operating characteristic curve (ROC) was used to analyze the predictive value of MP and LUS scores at 0 h and 72 h for the prognosis (28-day mortality rate) of patients with moderate to severe ARDS. Results 121 patients were included in the analysis, of which 73 were male and 48 were female. When patients entered the ICU, their oxygenation index (t: 30885, P < 0.01), APACHE II score (t: 2.105, P < 0.05), and SOFA score (t: 4.134, P < 0.001) were higher in the death group than the survival group. The death group had significantly higher MP and LUS at each time point (0 h, 24 h, 48 h, and 72 h) compared to the survival group (all P < 0.05). There was a significant upward trend over time in the MP and LUS of the death group, contrasting to a significant downward trend in the survival group (all P < 0.05). The Pearson correlation analysis showed that MP and LUS were significantly positively correlated at each time point (r values: 0 h: 0.3027; 24 h: 0.3705; 48 h: 0.3902; 72 h: 0.5916; all P < 0.01). The ROC curves showed that MP and LUS at 72 h were of significant value in predicting the prognosis of ARDS patients, with areas under the curve of 0.866 ± 0.032 and 0.839 ± 0.037, respectively. Conclusion There was a significant correlation between the MP and LUS of ARDS patients at four time points from 0 to 72 h, which has a clinical value in evaluating severity and prognosis.
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Wendel Garcia PD, Hofmaenner DA, Brugger SD, Acevedo CT, Bartussek J, Camen G, Bader PR, Bruellmann G, Kattner J, Ganter C, Schuepbach RA, Buehler PK. Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS. J Intensive Care Med 2021; 36:1184-1193. [PMID: 34098803 PMCID: PMC8442133 DOI: 10.1177/08850666211024139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Lung-protective ventilation is key in bridging patients suffering from
COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However,
resource and personnel limitations during pandemics complicate the
implementation of lung-protective protocols. Automated ventilation modes may
prove decisive in these settings enabling higher degrees of lung-protective
ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill,
mechanically ventilated COVID-19 ARDS patients were allocated, by
study-blinded coordinating staff, to either closed-loop or conventional
mechanical ventilation, based on mechanical ventilator availability. Primary
outcome was the overall achieved percentage of lung-protective ventilation
in closed-loop versus conventional mechanical ventilation, assessed
minute-by-minute, during the initial 7 days and overall mechanical
ventilation time. Lung-protective ventilation was defined as the combined
target of tidal volume <8 ml per kg of ideal body weight, dynamic driving
pressure <15 cmH2O, peak pressure <30 cmH2O,
peripheral oxygen saturation ≥88% and dynamic mechanical power <17
J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of
cumulative mechanical ventilation, allocated to either closed-loop (n = 23)
or conventional ventilation (n = 17), presenting with a median
paO2/ FiO2 ratio of 92 [72-147] mmHg and a static
compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated
for 11 [4-25] days and had a 28-day mortality rate of 20%. During the
initial 7 days of mechanical ventilation, patients in the closed-loop group
were ventilated lung-protectively for 65% of the time versus 38% in the
conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P
< 0.001) and for 45% versus 33% of overall mechanical ventilation time
(Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during
an early highpoint of the pandemic, mechanical ventilation using a
closed-loop mode was associated with a higher degree of lung-protective
ventilation than was conventional mechanical ventilation.
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Affiliation(s)
| | | | - Silvio D Brugger
- Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio T Acevedo
- Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Raphael Bader
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Gregor Bruellmann
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Johannes Kattner
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Christoph Ganter
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Reto Andreas Schuepbach
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
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Gong J, Zhang B, Huang X, Li B, Huang J. Product of driving pressure and respiratory rate for predicting weaning outcomes. J Int Med Res 2021; 49:3000605211010045. [PMID: 33969736 PMCID: PMC8113923 DOI: 10.1177/03000605211010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Clinicians cannot precisely determine the time for withdrawal of ventilation.
We aimed to evaluate the performance of driving pressure (DP)×respiratory
rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot)
were measured during mechanical ventilation with brief deep sedation and on
volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and
a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients
holding their breath for 2 s after inhalation and exhalation, respectively.
DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index
was measured from the ventilator. The highest RR was recorded within 3
minutes during a spontaneous breathing trial. Patients who tolerated a
spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation
withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the
success group and 230.2±52.2 cmH2O breaths/minute in the failure
group. A DP×RR index >170.8 cmH2O breaths/minute had a
sensitivity of 93.2% and specificity of 88.5% to predict failure of
weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the
weaning outcome. A high DP×RR increases the likelihood of weaning
failure. Statement: This manuscript was previously posted as a preprint
on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI:
10.21203/rs.2.24506/v3
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Affiliation(s)
- Ju Gong
- Department of Emergency Medicine, The First affiliated Hospital of Soochow University, Suzhou, China
| | - Bibo Zhang
- Department of Emergency Medicine, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Xiaowen Huang
- Department of Acupuncture and Tuina, Changshu Hospital of Traditional Chinese Medicine, Changshu, China
| | - Bin Li
- Department of Critical Care Medicine, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Jian Huang
- Department of Emergency Medicine, The First affiliated Hospital of Soochow University, Suzhou, China
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Cammarota G, Verdina F, De Vita N, Boniolo E, Tarquini R, Messina A, Zanoni M, Navalesi P, Vetrugno L, Bignami E, Corte FD, De Robertis E, Santangelo E, Vaschetto R. Effects of Varying Levels of Inspiratory Assistance with Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist on Driving Pressure in Patients Recovering from Hypoxemic Respiratory Failure. J Clin Monit Comput 2021; 36:419-427. [PMID: 33559864 PMCID: PMC7871131 DOI: 10.1007/s10877-021-00668-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022]
Abstract
Background Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV vs NAVA. Methods 16 intubated adult patients, recovering from hypoxemic acute respiratory failure (ARF) and undergoing assisted ventilation, were randomly subjected to six 30-min-lasting trials. At baseline, PSV (PSV100) was set with the same regulation present at patient enrollment. The corresponding level of NAVA (NAVA100) was set to match the same inspiratory peak of airway pressure obtained in PSV100. Therefore, the level of assistance was reduced and increased by 50% in both ventilatory modes (PSV50, NAVA50; PSV150, NAVA150). At the end of each trial, driving pressure obtained in response to four short (2–3 s) end-expiratory and end-inspiratory occlusions was analyzed. Results Driving pressure at PSV50 (6.6 [6.1–7.8] cmH2O) was lower than that recorded at PSV100 (7.9 [7.2–9.1] cmH2O, P = 0.005) and PSV150 (9.9 [9.1–13.2] cmH2O, P < 0.0001). In NAVA, driving pressure at NAVA50 was reduced compared to NAVA150 (7.7 [5.1–8.1] cmH2O vs 8.3 [6.4–11.4] cmH2O, P = 0.013), whereas there were no changes between baseline and NAVA150 (8.5 [6.3–9.8] cmH2O vs 8.3 [6.4–11.4] cmH2O, P = 0.331, respectively). Driving pressure at PSV150 was higher than that observed in NAVA150 (P = 0.011). Conclusions NAVA delivers better lung-protective ventilation compared to PSV in hypoxemic ARF patients. Trial registration number and date of registration The present trial was prospectively registered at www.clinicatrials.gov (NCT03719365) on 24 October 2018
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Affiliation(s)
- Gianmaria Cammarota
- Anesthesia and General Intensive Care, "Maggiore Della Carità" University Hospital, Novara, Italy. .,Department of Medicine and Surgery, Università Degli Studi Di Perugia, Perugia, Italy.
| | - Federico Verdina
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nello De Vita
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Ester Boniolo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Riccardo Tarquini
- Anesthesia and General Intensive Care, "Maggiore Della Carità" University Hospital, Novara, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Marta Zanoni
- Anesthesia and General Intensive Care, "Maggiore Della Carità" University Hospital, Novara, Italy
| | - Paolo Navalesi
- Department of Medicine, University of Padua, Padova, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, Università Di Udine, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Università Degli Studi Di Perugia, Perugia, Italy
| | - Erminio Santangelo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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12
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Kheyfets VO, Lammers SR, Wagner J, Bartels K, Piccoli J, Smith BJ. PEEP/ FIO2 ARDSNet Scale Grouping of a Single Ventilator for Two Patients: Modeling Tidal Volume Response. Respir Care 2020; 65:1094-1103. [PMID: 32712582 DOI: 10.4187/respcare.07931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic is creating ventilator shortages in many countries that is sparking a conversation about placing multiple patients on a single ventilator. However, on March 26, 2020, six leading medical organizations released a joint statement warning clinicians that attempting this technique could lead to poor outcomes and high mortality. Nevertheless, hospitals around the United States and abroad are considering this technique out of desperation (eg, New York), but there is little data to guide their approach. The overall objective of this study is to utilize a computational model of mechanically ventilated lungs to assess how patient-specific lung mechanics and ventilator settings impact lung tidal volume (VT). METHODS We developed a lumped-parameter computational model of multiple patients connected to a shared ventilator and validated it against a similar experimental study. We used this model to evaluate how patient-specific lung compliance and resistance would impact VT under 4 ventilator settings of pressure control level, PEEP, breathing frequency, and inspiratory:expiratory ratio. RESULTS Our computational model predicts VT within 10% of experimental measurements. Using this model to perform a parametric study, we provide proof-of-concept for an algorithm to better match patients in different hypothetical scenarios of a single ventilator shared by > 1 patient. CONCLUSIONS Assigning patients to preset ventilators based on their required level of support on the lower PEEP/higher [Formula: see text] scale of the National Institute of Health's National Heart, Lung, and Blood Institute ARDS Clinical Network (ARDSNet), secondary to lung mechanics, could be used to overcome some of the legitimate concerns of placing multiple patients on a single ventilator. We emphasize that our results are currently based on a computational model that has not been validated against any preclinical or clinical data. Therefore, clinicians considering this approach should not look to our study as an exact estimate of predicted patient VT values.
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Affiliation(s)
- Vitaly O Kheyfets
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
| | - Steven R Lammers
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer Wagner
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Karsten Bartels
- Department of Anesthesiology, Psychiatry, Medicine, and Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jerome Piccoli
- University of Colorado School of Medicine, Aurora, Colorado
| | - Bradford J Smith
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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13
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Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No. Crit Care Med 2020; 47:1147-1149. [PMID: 31162204 DOI: 10.1097/ccm.0000000000003865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Abstract
BACKGROUND This study hypothesized that, in experimental mild acute respiratory distress syndrome, lung damage caused by high tidal volume (VT) could be attenuated if VT increased slowly enough to progressively reduce mechanical heterogeneity and to allow the epithelial and endothelial cells, as well as the extracellular matrix of the lung to adapt. For this purpose, different strategies of approaching maximal VT were tested. METHODS Sixty-four Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomly assigned to receive mechanical ventilation with VT = 6 ml/kg for 2 h (control); VT = 6 ml/kg during hour 1 followed by an abrupt increase to VT = 22 ml/kg during hour 2 (no adaptation time); VT = 6 ml/kg during the first 30 min followed by a gradual VT increase up to 22 ml/kg for 30 min, then constant VT = 22 ml/kg during hour 2 (shorter adaptation time); and a more gradual VT increase, from 6 to 22 ml/kg during hour 1 followed by VT = 22 ml/kg during hour 2 (longer adaptation time). All animals were ventilated with positive end-expiratory pressure of 3 cm H2O. Nonventilated animals were used for molecular biology analysis. RESULTS At 2 h, diffuse alveolar damage score and heterogeneity index were greater in the longer adaptation time group than in the control and shorter adaptation time animals. Gene expression of interleukin-6 favored the shorter (median [interquartile range], 12.4 [9.1-17.8]) adaptation time compared with longer (76.7 [20.8 to 95.4]; P = 0.02) and no adaptation (65.5 [18.1 to 129.4]) time (P = 0.02) strategies. Amphiregulin, metalloproteinase-9, club cell secretory protein-16, and syndecan showed similar behavior. CONCLUSIONS In experimental mild acute respiratory distress syndrome, lung damage in the shorter adaptation time group compared with the no adaptation time group was attenuated in a time-dependent fashion by preemptive adaptation of the alveolar epithelial cells and extracellular matrix. Extending the adaptation period increased cumulative power and did not prevent lung damage, because it may have exposed animals to injurious strain earlier and for a longer time, thereby negating any adaptive benefit.
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15
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Nieman GF, Al-Khalisy H, Kollisch-Singule M, Satalin J, Blair S, Trikha G, Andrews P, Madden M, Gatto LA, Habashi NM. A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung. Front Physiol 2020; 11:227. [PMID: 32265734 PMCID: PMC7096584 DOI: 10.3389/fphys.2020.00227] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) causes a heterogeneous lung injury and remains a serious medical problem, with one of the only treatments being supportive care in the form of mechanical ventilation. It is very difficult, however, to mechanically ventilate the heterogeneously damaged lung without causing secondary ventilator-induced lung injury (VILI). The acutely injured lung becomes time and pressure dependent, meaning that it takes more time and pressure to open the lung, and it recollapses more quickly and at higher pressure. Current protective ventilation strategies, ARDSnet low tidal volume (LVt) and the open lung approach (OLA), have been unsuccessful at further reducing ARDS mortality. We postulate that this is because the LVt strategy is constrained to ventilating a lung with a heterogeneous mix of normal and focalized injured tissue, and the OLA, although designed to fully open and stabilize the lung, is often unsuccessful at doing so. In this review we analyzed the pathophysiology of ARDS that renders the lung susceptible to VILI. We also analyzed the alterations in alveolar and alveolar duct mechanics that occur in the acutely injured lung and discussed how these alterations are a key mechanism driving VILI. Our analysis suggests that the time component of each mechanical breath, at both inspiration and expiration, is critical to normalize alveolar mechanics and protect the lung from VILI. Animal studies and a meta-analysis have suggested that the time-controlled adaptive ventilation (TCAV) method, using the airway pressure release ventilation mode, eliminates the constraints of ventilating a lung with heterogeneous injury, since it is highly effective at opening and stabilizing the time- and pressure-dependent lung. In animal studies it has been shown that by “casting open” the acutely injured lung with TCAV we can (1) reestablish normal expiratory lung volume as assessed by direct observation of subpleural alveoli; (2) return normal parenchymal microanatomical structural support, known as alveolar interdependence and parenchymal tethering, as assessed by morphometric analysis of lung histology; (3) facilitate regeneration of normal surfactant function measured as increases in surfactant proteins A and B; and (4) significantly increase lung compliance, which reduces the pathologic impact of driving pressure and mechanical power at any given tidal volume.
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Affiliation(s)
- Gary F Nieman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Hassan Al-Khalisy
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | | | - Joshua Satalin
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Sarah Blair
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Girish Trikha
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Penny Andrews
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Maria Madden
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Louis A Gatto
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States.,Department of Biological Sciences, SUNY Cortland, Cortland, NY, United States
| | - Nader M Habashi
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
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16
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Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung 2019; 49:427-434. [PMID: 31733881 DOI: 10.1016/j.hrtlng.2019.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Driving pressure (ΔP) and mechanical power (MP) are predictors of the risk of ventilation- induced lung injuries (VILI) in mechanically ventilated patients. INTELLiVENT-ASV® is a closed-loop ventilation mode that automatically adjusts respiratory rate and tidal volume, according to the patient's respiratory mechanics. OBJECTIVES This prospective observational study investigated ΔP and MP (and also transpulmonary ΔP (ΔPL) and MP (MPL) for a subgroup of patients) delivered by INTELLiVENT-ASV. METHODS Adult patients admitted to the ICU were included if they were sedated and met the criteria for a single lung condition (normal lungs, COPD, or ARDS). INTELLiVENT-ASV was used with default target settings. If PEEP was above 16 cmH2O, the recruitment strategy used transpulmonary pressure as a reference, and ΔPL and MPL were computed. Measurements were made once for each patient. RESULTS Of the 255 patients included, 98 patients were classified as normal-lungs, 28 as COPD, and 129 as ARDS patients. The median ΔP was 8 (7 - 10), 10 (8 - 12), and 9 (8 - 11) cmH2O for normal-lungs, COPD, and ARDS patients, respectively. The median MP was 9.1 (4.9 - 13.5), 11.8 (8.6 - 16.5), and 8.8 (5.6 - 13.8) J/min for normal-lungs, COPD, and ARDS patients, respectively. For the 19 patients managed with transpulmonary pressure ΔPL was 6 (4 - 7) cmH2O and MPL was 3.6 (3.1 - 4.4) J/min. CONCLUSIONS In this short term observation study, INTELLiVENT-ASV selected ΔP and MP considered in safe ranges for lung protection. In a subgroup of ARDS patients, the combination of a recruitment strategy and INTELLiVENT-ASV resulted in an apparently safe ΔPL and MPL.
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Affiliation(s)
- Jean-Michel Arnal
- Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France; Department of Medical Research, Hamilton Medical AG, via Crusch 8, 7402 Bonaduz, Switzerland.
| | - Mathieu Saoli
- Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France
| | - Aude Garnero
- Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France
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18
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Grune J, Tabuchi A, Kuebler WM. Alveolar dynamics during mechanical ventilation in the healthy and injured lung. Intensive Care Med Exp 2019; 7:34. [PMID: 31346797 PMCID: PMC6658629 DOI: 10.1186/s40635-019-0226-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/12/2023] Open
Abstract
Mechanical ventilation is a life-saving therapy in patients with acute respiratory distress syndrome (ARDS). However, mechanical ventilation itself causes severe co-morbidities in that it can trigger ventilator-associated lung injury (VALI) in humans or ventilator-induced lung injury (VILI) in experimental animal models. Therefore, optimization of ventilation strategies is paramount for the effective therapy of critical care patients. A major problem in the stratification of critical care patients for personalized ventilation settings, but even more so for our overall understanding of VILI, lies in our limited insight into the effects of mechanical ventilation at the actual site of injury, i.e., the alveolar unit. Unfortunately, global lung mechanics provide for a poor surrogate of alveolar dynamics and methods for the in-depth analysis of alveolar dynamics on the level of individual alveoli are sparse and afflicted by important limitations. With alveolar dynamics in the intact lung remaining largely a "black box," our insight into the mechanisms of VALI and VILI and the effectiveness of optimized ventilation strategies is confined to indirect parameters and endpoints of lung injury and mortality.In the present review, we discuss emerging concepts of alveolar dynamics including alveolar expansion/contraction, stability/instability, and opening/collapse. Many of these concepts remain still controversial, in part due to limitations of the different methodologies applied. We therefore preface our review with an overview of existing technologies and approaches for the analysis of alveolar dynamics, highlighting their individual strengths and limitations which may provide for a better appreciation of the sometimes diverging findings and interpretations. Joint efforts combining key technologies in identical models to overcome the limitations inherent to individual methodologies are needed not only to provide conclusive insights into lung physiology and alveolar dynamics, but ultimately to guide critical care patient therapy.
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Affiliation(s)
- Jana Grune
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10117 Berlin, Germany
| | - Arata Tabuchi
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10117 Berlin, Germany
- The Keenan Research Centre for Biomedical Science at St. Michael’s, Toronto, Canada
- Departments of Surgery and Physiology, University of Toronto, Toronto, Canada
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van der Staay M, Chatburn RL. Advanced modes of mechanical ventilation and optimal targeting schemes. Intensive Care Med Exp 2018; 6:30. [PMID: 30136011 PMCID: PMC6104409 DOI: 10.1186/s40635-018-0195-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022] Open
Abstract
Recent research results provide new incentives to recognize and prevent ventilator-induced lung injury (VILI) and create targeting schemes for new modes of mechanical ventilation. For example, minimization of breathing power, inspiratory power, and inspiratory pressure are the underlying goals of optimum targeting schemes used in the modes called adaptive support ventilation (ASV), adaptive ventilation mode 2 (AVM2), and MID-frequency ventilation (MFV). We describe the mathematical models underlying these targeting schemes and present theoretical analyses for minimizing tidal volume, tidal pressure (also known as driving pressure), or tidal power as functions of ventilatory frequency. To go beyond theoretical equations, these targeting schemes were compared in terms of expected tidal volumes using different patient models. Results indicate that at the same ventilation efficiency (same PaCO2 level), we expect tidal volume dosage in the range of 7.4 mL/kg (for ASV), 6.2 mL/kg (for AVM2), and 6.7 mL/kg (for MFV) for adult ARDS simulation. For a neonatal RDS model, we expect 5.5 mL/kg (for ASV), 4.6 mL/kg (for AVM2), and 4.5 (for MFV).
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