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Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen Department of Intensive Care Unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China Department of Intensive Care Unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical ventilation.The cut-off values of the medianΔP%measured by Operator 1 vs.Operator 2 in the first 4 days were≥4.17%and 4.55%,respectively(p<0.001),with the area under curve of 0.804(sensitivity of 88.2%,specificity of 64.7%)and 0.770(sensitivity of 88.2%,specificity of 64.7%),respectively.There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8%vs.66.7%,

关键词： driving pressure driving pressure variation rate Acute respiratory distress syndrome Mechanical ventilation

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driving pressure decoded:Precision strategies in adult respiratory distress syndrome management

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World Journal of Critical Care Medicine 2024年第2期13卷 15-18页

作者： Muhammad Adrish Sai Doppalapudi Dmitry Lvovsky Department of Medicine Baylor College of MedicineHoustonTX 77030United States Department of Medicine BronxCare Health System/Icahn School of Medicine at Mount SinaiBronxNY 10467United States

Mechanical ventilation(MV)is an important strategy for improving the survival of patients with respiratory failure.However,MV is associated with aggravation of lung injury,with ventilator-induced lung injury(VILI)becoming a major concern.Thus,ventilation protection strategies have been developed to minimize complications from MV,with the goal of relieving excessive breathing workload,improving gas exchange,and minimizing VILI.By opting for lower tidal volumes,clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli,which can contribute to lung injury.Additionally,other factors play a role in optimizing lung protection during MV,including adequate positive end-expiratory pressure levels,to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.

关键词： driving pressure Mechanical ventilation Lung-protective ventilation strategies Ventilator-induced lung injury

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driving pressure in mechanical ventilation:A review

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World Journal of Critical Care Medicine 2024年第1期13卷 15-27页

作者： Syeda Farheen Zaidi Asim Shaikh Daniyal Aziz Khan Salim Surani Iqbal Ratnani Department of Medicine Queen Mary UniversityLondon E14NSUnited Kingdom Department of Medicine Aga Khan UniversitySindhKarachi 74500Pakistan Department of Medicine Jinnah Postgraduate Medical CenterSindhKarachi 75510Pakistan Department of Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Department of Anesthesiology and Critical Care Houston Methodist HospitalHoustonTX 77030United States

driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

关键词： driving pressure Acute respiratory distress syndrome Mortality Positive end-expiratory pressure Ventilator induced lung injury Mechanical ventilation

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Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome:A retrospective,observational cohort study

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Journal of Intensive Medicine 2024年第2期4卷 194-201页

作者： Sylvain Le Pape Florent Joly François Arrivé Jean-Pierre Frat Maeva Rodriguez Maïa Joos Laura Marchasson Mathilde Wairy Arnaud WThille Rémi Coudroy Centre Hospitalier Universitaire de Poitiers Service de Médecine Intensive RéanimationPoitiersFrance INSERM Centre d'Investigation Clinique 1402 IS-ALIVE Research GroupUniversitéde PoitiersPoitiersFrance

Background Extracorporeal membrane oxygenation(ECMO)for acute respiratory distress syndrome(ARDS)is systematically associated with decreased respiratory system compliance(CRS).It remains unclear whether transportation to the referral ECMO center,changes in ventilatory mode or settings to achieve ultra-protective ventilation,or the natural evolution of ARDS drives this change in respiratory mechanics.Herein,we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.Methods To rule out the effect of transportation and the different modes of ventilation on CRS,we conducted a retrospective,single-center,observational cohort study from January 2013 to May 2020,on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation.CRS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation.The primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO cannulation.The secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time point.Results CRS decreased within the first 3 h after ECMO cannulation(−28.3%,95%confidence interval[CI]:−38.8 to−17.9,Pdriving pressure by−8.3 cmH2O(95%CI:−11.2 to−5.3),resulting in decreased tidal volume by−3.3 mL/kg of predicted body weight(95%CI:−3.9 to−2.6)as compared to before ECMO cannulation(Ppressure reduction,driving pressure reduction,and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation,whereas neither respiratory rate,positive end-expiratory pressure,inspired fraction of oxygen,fluid balance

关键词： Acute respiratory distress syndrome Extracorporeal membrane oxygenation driving pressure Respiratory compliance

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