Pleural Pressure Targeted Positive Airway Pressure Improves Cardiopulmonary Function in Spontaneously Breathing Patients With Obesity
| Autor: | Aranya Bagchi, Abraham Sonny, Gaetano Florio, Angela K. Fitch, Pankaj Arora, Francesco Marrazzo, Chika V. Anekwe, Lorenzo Berra, Marcelo B. P. Amato, Jacopo Fumagalli, Robert M. Kacmarek, David A. Imber, Roberta R. De Santis Santiago |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Supine position Hemodynamics Critical Care and Intensive Care Medicine 03 medical and health sciences Work of breathing 0302 clinical medicine Esophagus Internal medicine Positive airway pressure medicine Pressure Tidal Volume Humans 030212 general & internal medicine Obesity Tidal volume Pleural Cavity Lung business.industry Pulmonary Gas Exchange Airway Resistance Respiration respiratory tract diseases medicine.anatomical_structure 030228 respiratory system Cardiology Breathing Cardiology and Cardiovascular Medicine business Respiratory minute volume |
| Zdroj: | Chest. 159(6) |
| ISSN: | 1931-3543 |
| Popis: | Background Increased pleural pressure affects the mechanics of breathing of people with class III obesity (BMI > 40 kg/m2). Research Question What are the acute effects of CPAP titrated to match pleural pressure on cardiopulmonary function in spontaneously breathing patients with class III obesity? Study design and Methods We enrolled six participants with BMI within normal range (control participants, group I) and 12 patients with class III obesity (group II) divided into subgroups: IIa, BMI of 40 to 50 kg/m2; and IIb, BMI of ≥ 50 kg/m2. The study was performed in two phases: in phase 1, participants were supine and breathing spontaneously at atmospheric pressure, and in phase 2, participants were supine and breathing with CPAP titrated to match their end-expiratory esophageal pressure in the absence of CPAP. Respiratory mechanics, esophageal pressure, and hemodynamic data were collected, and right heart function was evaluated by transthoracic echocardiography. Results The levels of CPAP titrated to match pleural pressure in group I, subgroup IIa, and subgroup IIb were 6 ± 2 cmH2O, 12 ± 3 cmH2O, and 18 ± 4 cmH2O, respectively. In both subgroups IIa and IIb, CPAP titrated to match pleural pressure decreased minute ventilation (IIa, P = .03; IIb, P = .03), improved peripheral oxygen saturation (IIa, P = .04; IIb, P = .02), improved homogeneity of tidal volume distribution between ventral and dorsal lung regions (IIa, P = .22; IIb, P = .03), and decreased work of breathing (IIa, P Interpretation In ambulatory patients with class III obesity, CPAP titrated to match pleural pressure decreased work of breathing and improved respiratory mechanics while maintaining hemodynamic stability, without impairing right heart function. Trial Registry ClinicalTrials.gov; No.: NCT02523352; URL: www.clinicaltrials.gov |
| Databáze: | OpenAIRE |
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