Effect of increased resistance on dynamic compliance assessed by two clinical monitors during volume-controlled ventilation: A test-lung study.

Autor: Ben-Aderet D; William Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA., Soares JH; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA. Electronic address: jhsoares@ucdavis.edu., Bueno ML; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.
Jazyk: angličtina
Zdroj: Veterinary anaesthesia and analgesia [Vet Anaesth Analg] 2024 Jul-Aug; Vol. 51 (4), pp. 322-332. Date of Electronic Publication: 2024 Mar 09.
DOI: 10.1016/j.vaa.2024.03.003
Abstrakt: Objective: To evaluate the effect of increased respiratory system resistance (R RS ) on dynamic compliance (C dyn ) assessed by the NM3 monitor (C dyn(NM3) ) and the E-CAiOV module (C dyn(ECAiOV) ).
Study Design: Prospective laboratory study.
Methods: A training test lung (TTL) simulated the mechanical ventilation of a mammal with 50 and 300 mL tidal volumes in three conditions of R RS [normal (R BL ), moderately increased (R 1 ) and severely increased (R 2 )] and a wide range of clinically relevant C dyn . Simulations at increased R RS were paired with simulations at R BL with the same static compliance for comparisons. Pearson's correlation coefficient and concordance correlation coefficient between the measurements at R BL with the ones with increased R RS were calculated. Bland-Altman plots were also used to evaluate the agreement of C dyn(ECAiOV) and C dyn(NM3) at R BL (control values) with their paired values at R 1 and R 2 . Relative bias and limits of agreement (LOAs) were calculated and LOAs larger than 30% were considered unacceptable. Trending ability of C dyn(NM3) and C dyn(ECAiOV) were evaluated by polar plots. Values of p < 0.05 were considered significant.
Results: The effect of increased R RS was more pronounced for C dyn(ECAiOV) than for C dyn(NM3) . Unacceptable agreement was only observed in C dyn(NM3) at R 2 in the 300 mL simulation (bias = -18.3% and lower LOA = -45%). For C dyn(ECAiOV) , agreement was unacceptable for all tested R RS in both simulations, being the worst at R 2 in the 300 mL simulation (bias = -54.7% and lower LOA = -100.2%). Both levels of increased R RS caused poor trending ability for C dyn(ECAiOV) , whereas the same effect was only observed for C dyn(NM3) at R 2 .
Conclusions and Clinical Relevance: In the presence of increased R RS , C dyn estimated by the NM3 monitor presented better capability to distinguish between changes in R RS from changes in respiratory system compliance.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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