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Bastia L, Amendolagine L, Pozzi F, Carenini S, Cipolla C, Curto F, Bellani G, Fumagalli R, Chieregato A. Reliability of Respiratory System Compliance Calculation During Assisted Mechanical Ventilation: A Retrospective Study. Crit Care Med 2023; 51:e201-e205. [PMID: 37326475 DOI: 10.1097/ccm.0000000000005964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To compare respiratory system compliance (C rs ) calculation during controlled mechanical ventilation (MV) and, subsequently, during assisted MV. DESIGN This is a single-center, retrospective, observational study. SETTING This study was conducted on patients admitted to Neuro-ICU of Niguarda Hospital (tertiary referral hospital). PATIENTS We analyzed every patient greater than or equal to 18 years old having a C rs measurement in controlled and in assisted MV within 60 minutes. Plateau pressure (P plat ) was considered reliable if it was deemed visually stable for at least 2 seconds. INTERVENTIONS Inspiratory pause was incorporated to detect P plat in controlled and assisted MV. Calculation of C rs and driving pressure were achieved. MEASUREMENTS AND MAIN RESULTS A total of 101 patients were studied. An acceptable agreement was found (Bland-Altman plot bias -3.9, level of agreement upper 21.6, lower -29.6). C rs in assisted MV was 64.1 (52.6-79.3) and in controlled MV it was 61.2 (50-71.2) mL/cm H 2o ( p = 0.006). No statistical difference was found in C rs (assisted vs controlled MV) when peak pressure was lower than P plat nor when peak pressure was higher than P plat . CONCLUSIONS A P plat visually stable for at least 2 seconds leads to reliable C rs calculation during assisted MV.
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Affiliation(s)
- Luca Bastia
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Federico Pozzi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Carenini
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristiana Cipolla
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Curto
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Bellani
- Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arturo Chieregato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Bianchi I, Grassi A, Pham T, Telias I, Teggia Droghi M, Vieira F, Jonkman A, Brochard L, Bellani G. Reliability of plateau pressure during patient-triggered assisted ventilation. Analysis of a multicentre database. J Crit Care 2021; 68:96-103. [PMID: 34952477 DOI: 10.1016/j.jcrc.2021.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/20/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE An inspiratory hold during patient-triggered assisted ventilation potentially allows to measure driving pressure and inspiratory effort. However, muscular activity can make this measurement unreliable. We aim to define the criteria for inspiratory holds reliability during patient-triggered breaths. MATERIAL AND METHODS Flow, airway and esophageal pressure recordings during patient-triggered breaths from a multicentre observational study (BEARDS, NCT03447288) were evaluated by six independent raters, to determine plateau pressure readability. Features of "readable" and "unreadable" holds were compared. Muscle pressure estimate from the hold was validated against other measures of inspiratory effort. RESULTS Ninety-two percent of the recordings were consistently judged as readable or unreadable by at least four raters. Plateau measurement showed a high consistency among raters. A short time from airway peak to plateau pressure and a stable and longer plateau characterized readable holds. Unreadable plateaus were associated with higher indexes of inspiratory effort. Muscular pressure computed from the hold showed a strong correlation with independent indexes of inspiratory effort. CONCLUSION The definition of objective parameters of plateau reliability during assisted-breath provides the clinician with a tool to target a safer assisted-ventilation and to detect the presence of high inspiratory effort.
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Affiliation(s)
- Isabella Bianchi
- Department of Anesthesia and Intensive Care Medicine, Papa Giovanni XXXIII Hospital, Bergamo, Italy; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Clinical-Surgical, diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Alice Grassi
- Department of Anesthesia and Pain Medicine, University of Toronto, Ontario, Canada; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
| | - Tài Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Le Kremlin-Bicêtre, France.
| | - Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.
| | - Maddalena Teggia Droghi
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
| | - Fernando Vieira
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Annemijn Jonkman
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands.
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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Flow Index accurately identifies breaths with low or high inspiratory effort during pressure support ventilation. Crit Care 2021; 25:427. [PMID: 34911541 PMCID: PMC8672539 DOI: 10.1186/s13054-021-03855-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/03/2021] [Indexed: 01/19/2023] Open
Abstract
Background Flow Index, a numerical expression of the shape of the inspiratory flow-time waveform recorded during pressure support ventilation, is associated with patient inspiratory effort. The aim of this study was to assess the accuracy of Flow Index in detecting high or low inspiratory effort during pressure support ventilation and to establish cutoff values for the Flow index to identify these conditions. The secondary aim was to compare the performance of Flow index,of breathing pattern parameters and of airway occlusion pressure (P0.1) in detecting high or low inspiratory effort during pressure support ventilation. Methods Data from 24 subjects was included in the analysis, accounting for a total of 702 breaths. Breaths with high inspiratory effort were defined by a pressure developed by inspiratory muscles (Pmusc) greater than 10 cmH2O while breaths with low inspiratory effort were defined by a Pmusc lower than 5 cmH2O. The areas under the receiver operating characteristic curves of Flow Index and respiratory rate, tidal volume,respiratory rate over tidal volume and P0.1 were analyzed and compared to identify breaths with low or high inspiratory effort. Results Pmusc, P0.1, Pressure Time Product and Flow Index differed between breaths with high, low and intermediate inspiratory effort, while RR, RR/VT and VT/kg of IBW did not differ in a statistically significant way. A Flow index higher than 4.5 identified breaths with high inspiratory effort [AUC 0.89 (CI 95% 0.85–0.93)], a Flow Index lower than 2.6 identified breaths with low inspiratory effort [AUC 0.80 (CI 95% 0.76–0.83)]. Conclusions Flow Index is accurate in detecting high and low spontaneous inspiratory effort during pressure support ventilation. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03855-4.
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Park JE, Kim TY, Jung YJ, Han C, Park CM, Park JH, Park KJ, Yoon D, Chung WY. Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179229. [PMID: 34501829 PMCID: PMC8430549 DOI: 10.3390/ijerph18179229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
We evaluated new features from biosignals comprising diverse physiological response information to predict the outcome of weaning from mechanical ventilation (MV). We enrolled 89 patients who were candidates for weaning from MV in the intensive care unit and collected continuous biosignal data: electrocardiogram (ECG), respiratory impedance, photoplethysmogram (PPG), arterial blood pressure, and ventilator parameters during a spontaneous breathing trial (SBT). We compared the collected biosignal data's variability between patients who successfully discontinued MV (n = 67) and patients who did not (n = 22). To evaluate the usefulness of the identified factors for predicting weaning success, we developed a machine learning model and evaluated its performance by bootstrapping. The following markers were different between the weaning success and failure groups: the ratio of standard deviations between the short-term and long-term heart rate variability in a Poincaré plot, sample entropy of ECG and PPG, α values of ECG, and respiratory impedance in the detrended fluctuation analysis. The area under the receiver operating characteristic curve of the model was 0.81 (95% confidence interval: 0.70-0.92). This combination of the biosignal data-based markers obtained during SBTs provides a promising tool to assist clinicians in determining the optimal extubation time.
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Affiliation(s)
- Ji Eun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea; (J.E.P.); (Y.J.J.); (J.H.P.); (K.J.P.)
| | | | - Yun Jung Jung
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea; (J.E.P.); (Y.J.J.); (J.H.P.); (K.J.P.)
| | - Changho Han
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin 16995, Korea; (C.H.); (C.M.P.)
| | - Chan Min Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin 16995, Korea; (C.H.); (C.M.P.)
| | - Joo Hun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea; (J.E.P.); (Y.J.J.); (J.H.P.); (K.J.P.)
| | - Kwang Joo Park
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea; (J.E.P.); (Y.J.J.); (J.H.P.); (K.J.P.)
| | - Dukyong Yoon
- BUD.on Inc., Jeonju 54871, Korea;
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin 16995, Korea; (C.H.); (C.M.P.)
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin 16995, Korea
- Correspondence: (D.Y.); (W.Y.C.); Tel.: +82-31-5189-8450 (D.Y.); +82-31-219-5120 (W.Y.C.)
| | - Wou Young Chung
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea; (J.E.P.); (Y.J.J.); (J.H.P.); (K.J.P.)
- Correspondence: (D.Y.); (W.Y.C.); Tel.: +82-31-5189-8450 (D.Y.); +82-31-219-5120 (W.Y.C.)
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Baumann P, Cannizzaro V. Lung function assessment in critically ill children: craving for standardisation. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Albani F, Pisani L, Ciabatti G, Fusina F, Buizza B, Granato A, Lippolis V, Aniballi E, Murgolo F, Rosano A, Latronico N, Antonelli M, Grasso S, Natalini G. Flow Index: a novel, non-invasive, continuous, quantitative method to evaluate patient inspiratory effort during pressure support ventilation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:196. [PMID: 34099028 PMCID: PMC8182360 DOI: 10.1186/s13054-021-03624-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/31/2021] [Indexed: 02/08/2023]
Abstract
Background The evaluation of patient effort is pivotal during pressure support ventilation, but a non-invasive, continuous, quantitative method to assess patient inspiratory effort is still lacking. We hypothesized that the concavity of the inspiratory flow-time waveform could be useful to estimate patient’s inspiratory effort. The purpose of this study was to assess whether the shape of the inspiratory flow, as quantified by a numeric indicator, could be associated with inspiratory effort during pressure support ventilation. Methods Twenty-four patients in pressure support ventilation were enrolled. A mathematical relationship describing the decay pattern of the inspiratory flow profile was developed. The parameter hypothesized to estimate effort was named Flow Index. Esophageal pressure, airway pressure, airflow, and volume waveforms were recorded at three support levels (maximum, minimum and baseline). The association between Flow Index and reference measures of patient effort (pressure time product and pressure generated by respiratory muscles) was evaluated using linear mixed effects models adjusted for tidal volume, respiratory rate and respiratory rate/tidal volume. Results Flow Index was different at the three pressure support levels and all group comparisons were statistically significant. In all tested models, Flow Index was independently associated with patient effort (p < 0.001). Flow Index prediction of inspiratory effort agreed with esophageal pressure-based methods. Conclusions Flow Index is associated with patient inspiratory effort during pressure support ventilation, and may provide potentially useful information for setting inspiratory support and monitoring patient-ventilator interactions. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03624-3.
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Affiliation(s)
- Filippo Albani
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Pisani
- Department of Anesthesia and Intensive Care, Miulli Regional Hospital, Acquaviva Delle Fonti, Bari, Italy.,Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Gianni Ciabatti
- Department of Anesthesiology, Neurointensive Care Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Federica Fusina
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy.
| | - Barbara Buizza
- Department of Anesthesia and Intensive Care, Spedali Civili, Brescia, Italy
| | - Anna Granato
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy
| | - Valeria Lippolis
- Department of Anesthesia and Intensive Care, Mater Dei Hospital, Bari, Italy
| | - Eros Aniballi
- Department of Anesthesia, I.R.C.C.S. MultiMedica, Sesto San Giovanni, Milano, Italy
| | - Francesco Murgolo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Rosano
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy
| | - Nicola Latronico
- Department of Anesthesia and Intensive Care, Spedali Civili, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Fondazione Policlinico, Universitario A. Gemelli, Roma, Italy
| | - Salvatore Grasso
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Natalini
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy
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Wang H, He H. Dynamic hyperinflation and intrinsic PEEP in ARDS patients: who, when, and how needs more focus? Crit Care 2019; 23:422. [PMID: 31870401 PMCID: PMC6929493 DOI: 10.1186/s13054-019-2713-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Heyan Wang
- Department of Critical Care Medicine, The Sixth Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Hangyong He
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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