| Autor: |
Sonal Mistry, Anup Das, Sina Saffaran, Nadir Yehya, Timothy E. Scott, Marc Chikhani, John G. Laffey, Jonathan G. Hardman, Luigi Camporota, Declan G. Bates |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
Respiratory Research, Vol 23, Iss 1, Pp 1-9 (2022) |
| Druh dokumentu: |
article |
| ISSN: |
1465-993X |
| DOI: |
10.1186/s12931-022-01985-z |
| Popis: |
Abstract Background Airway pressure release ventilation (APRV) is widely available on mechanical ventilators and has been proposed as an early intervention to prevent lung injury or as a rescue therapy in the management of refractory hypoxemia. Driving pressure ( $$\Delta P$$ Δ P ) has been identified in numerous studies as a key indicator of ventilator-induced-lung-injury that needs to be carefully controlled. $$\Delta P$$ Δ P delivered by the ventilator in APRV is not directly measurable in dynamic conditions, and there is no “gold standard” method for its estimation. Methods We used a computational simulator matched to data from 90 patients with acute respiratory distress syndrome (ARDS) to evaluate the accuracy of three “at-the-bedside” methods for estimating ventilator $$\Delta P$$ Δ P during APRV. Results Levels of $$\Delta P$$ Δ P delivered by the ventilator in APRV were generally within safe limits, but in some cases exceeded levels specified by protective ventilation strategies. A formula based on estimating the intrinsic positive end expiratory pressure present at the end of the APRV release provided the most accurate estimates of $$\Delta P$$ Δ P . A second formula based on assuming that expiratory flow, volume and pressure decay mono-exponentially, and a third method that requires temporarily switching to volume-controlled ventilation, also provided accurate estimates of true $$\Delta P$$ Δ P . Conclusions Levels of $$\Delta P$$ Δ P delivered by the ventilator during APRV can potentially exceed levels specified by standard protective ventilation strategies, highlighting the need for careful monitoring. Our results show that $$\Delta P$$ Δ P delivered by the ventilator during APRV can be accurately estimated at the bedside using simple formulae that are based on readily available measurements. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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