Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation
Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pres...
Ausführliche Beschreibung
Autor*in: |
Soundoulounaki, Stella [verfasserIn] Akoumianaki, Evangelia [verfasserIn] Kondili, Eumorfia [verfasserIn] Pediaditis, Emmanouil [verfasserIn] Prinianakis, Georgios [verfasserIn] Vaporidi, Katerina [verfasserIn] Georgopoulos, Dimitris [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
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2020 |
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Übergeordnetes Werk: |
Enthalten in: Critical care - London : BioMed Central, 1997, 24(2020), 1 vom: 28. Juli |
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Übergeordnetes Werk: |
volume:24 ; year:2020 ; number:1 ; day:28 ; month:07 |
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DOI / URN: |
10.1186/s13054-020-03169-x |
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Katalog-ID: |
SPR040490785 |
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520 | |a Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. | ||
650 | 4 | |a Esophageal pressure |7 (dpeaa)DE-He213 | |
650 | 4 | |a Gastric pressure |7 (dpeaa)DE-He213 | |
650 | 4 | |a Driving pressure |7 (dpeaa)DE-He213 | |
650 | 4 | |a Protective ventilation |7 (dpeaa)DE-He213 | |
700 | 1 | |a Akoumianaki, Evangelia |e verfasserin |4 aut | |
700 | 1 | |a Kondili, Eumorfia |e verfasserin |4 aut | |
700 | 1 | |a Pediaditis, Emmanouil |e verfasserin |4 aut | |
700 | 1 | |a Prinianakis, Georgios |e verfasserin |4 aut | |
700 | 1 | |a Vaporidi, Katerina |e verfasserin |4 aut | |
700 | 1 | |a Georgopoulos, Dimitris |e verfasserin |4 aut | |
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10.1186/s13054-020-03169-x doi (DE-627)SPR040490785 (SPR)s13054-020-03169-x-e DE-627 ger DE-627 rakwb eng 610 ASE 44.00 bkl Soundoulounaki, Stella verfasserin aut Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. Esophageal pressure (dpeaa)DE-He213 Gastric pressure (dpeaa)DE-He213 Driving pressure (dpeaa)DE-He213 Protective ventilation (dpeaa)DE-He213 Akoumianaki, Evangelia verfasserin aut Kondili, Eumorfia verfasserin aut Pediaditis, Emmanouil verfasserin aut Prinianakis, Georgios verfasserin aut Vaporidi, Katerina verfasserin aut Georgopoulos, Dimitris verfasserin aut Enthalten in Critical care London : BioMed Central, 1997 24(2020), 1 vom: 28. Juli (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:24 year:2020 number:1 day:28 month:07 https://dx.doi.org/10.1186/s13054-020-03169-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 ASE AR 24 2020 1 28 07 |
spelling |
10.1186/s13054-020-03169-x doi (DE-627)SPR040490785 (SPR)s13054-020-03169-x-e DE-627 ger DE-627 rakwb eng 610 ASE 44.00 bkl Soundoulounaki, Stella verfasserin aut Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. Esophageal pressure (dpeaa)DE-He213 Gastric pressure (dpeaa)DE-He213 Driving pressure (dpeaa)DE-He213 Protective ventilation (dpeaa)DE-He213 Akoumianaki, Evangelia verfasserin aut Kondili, Eumorfia verfasserin aut Pediaditis, Emmanouil verfasserin aut Prinianakis, Georgios verfasserin aut Vaporidi, Katerina verfasserin aut Georgopoulos, Dimitris verfasserin aut Enthalten in Critical care London : BioMed Central, 1997 24(2020), 1 vom: 28. Juli (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:24 year:2020 number:1 day:28 month:07 https://dx.doi.org/10.1186/s13054-020-03169-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 ASE AR 24 2020 1 28 07 |
allfields_unstemmed |
10.1186/s13054-020-03169-x doi (DE-627)SPR040490785 (SPR)s13054-020-03169-x-e DE-627 ger DE-627 rakwb eng 610 ASE 44.00 bkl Soundoulounaki, Stella verfasserin aut Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. Esophageal pressure (dpeaa)DE-He213 Gastric pressure (dpeaa)DE-He213 Driving pressure (dpeaa)DE-He213 Protective ventilation (dpeaa)DE-He213 Akoumianaki, Evangelia verfasserin aut Kondili, Eumorfia verfasserin aut Pediaditis, Emmanouil verfasserin aut Prinianakis, Georgios verfasserin aut Vaporidi, Katerina verfasserin aut Georgopoulos, Dimitris verfasserin aut Enthalten in Critical care London : BioMed Central, 1997 24(2020), 1 vom: 28. Juli (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:24 year:2020 number:1 day:28 month:07 https://dx.doi.org/10.1186/s13054-020-03169-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 ASE AR 24 2020 1 28 07 |
allfieldsGer |
10.1186/s13054-020-03169-x doi (DE-627)SPR040490785 (SPR)s13054-020-03169-x-e DE-627 ger DE-627 rakwb eng 610 ASE 44.00 bkl Soundoulounaki, Stella verfasserin aut Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. Esophageal pressure (dpeaa)DE-He213 Gastric pressure (dpeaa)DE-He213 Driving pressure (dpeaa)DE-He213 Protective ventilation (dpeaa)DE-He213 Akoumianaki, Evangelia verfasserin aut Kondili, Eumorfia verfasserin aut Pediaditis, Emmanouil verfasserin aut Prinianakis, Georgios verfasserin aut Vaporidi, Katerina verfasserin aut Georgopoulos, Dimitris verfasserin aut Enthalten in Critical care London : BioMed Central, 1997 24(2020), 1 vom: 28. Juli (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:24 year:2020 number:1 day:28 month:07 https://dx.doi.org/10.1186/s13054-020-03169-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 ASE AR 24 2020 1 28 07 |
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10.1186/s13054-020-03169-x doi (DE-627)SPR040490785 (SPR)s13054-020-03169-x-e DE-627 ger DE-627 rakwb eng 610 ASE 44.00 bkl Soundoulounaki, Stella verfasserin aut Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. Esophageal pressure (dpeaa)DE-He213 Gastric pressure (dpeaa)DE-He213 Driving pressure (dpeaa)DE-He213 Protective ventilation (dpeaa)DE-He213 Akoumianaki, Evangelia verfasserin aut Kondili, Eumorfia verfasserin aut Pediaditis, Emmanouil verfasserin aut Prinianakis, Georgios verfasserin aut Vaporidi, Katerina verfasserin aut Georgopoulos, Dimitris verfasserin aut Enthalten in Critical care London : BioMed Central, 1997 24(2020), 1 vom: 28. Juli (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:24 year:2020 number:1 day:28 month:07 https://dx.doi.org/10.1186/s13054-020-03169-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 ASE AR 24 2020 1 28 07 |
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Soundoulounaki, Stella @@aut@@ Akoumianaki, Evangelia @@aut@@ Kondili, Eumorfia @@aut@@ Pediaditis, Emmanouil @@aut@@ Prinianakis, Georgios @@aut@@ Vaporidi, Katerina @@aut@@ Georgopoulos, Dimitris @@aut@@ |
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Soundoulounaki, Stella |
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airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation |
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Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation |
abstract |
Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. |
abstractGer |
Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. |
abstract_unstemmed |
Background The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. Methods Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 $ cmH_{2} $O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. Conclusions The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure. |
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title_short |
Airway pressure morphology and respiratory muscle activity during end-inspiratory occlusions in pressure support ventilation |
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https://dx.doi.org/10.1186/s13054-020-03169-x |
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Akoumianaki, Evangelia Kondili, Eumorfia Pediaditis, Emmanouil Prinianakis, Georgios Vaporidi, Katerina Georgopoulos, Dimitris |
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Akoumianaki, Evangelia Kondili, Eumorfia Pediaditis, Emmanouil Prinianakis, Georgios Vaporidi, Katerina Georgopoulos, Dimitris |
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The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a “passive-like” decrease followed by plateau, a pattern with “clear plateau,” and an “irregular rise” pattern, which included all cases of late or continuous increase, with or without plateau. Results Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. 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