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Village Library
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Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS.
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- Author(s): Baedorf Kassis, Elias; Loring, Stephen; Talmor, Daniel; Loring, Stephen H
- Source:
Intensive Care Medicine; Aug2016, Vol. 42 Issue 8, p1206-1213, 8p- Subject Terms:
ADULT respiratory distress syndrome; RESPIRATORY organs; ARTIFICIAL respiration; BIOMARKERS; REGRESSION analysis; ADULT respiratory distress syndrome treatment; COMPARATIVE studies; ESOPHAGUS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; RETROSPECTIVE studies; RESPIRATORY mechanics; POSITIVE end-expiratory pressure - Source:
- Additional Information
- Abstract:
Purpose: The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure [plateau pressure-positive end-expiratory pressure (PEEP)] does not account for variable chest wall compliance. Esophageal manometry can be utilized to determine transpulmonary driving pressure. We have examined the relationships between respiratory system and transpulmonary driving pressure, pulmonary mechanics and 28-day mortality.Methods: Fifty-six patients from a previous study were analyzed to compare PEEP titration to maintain positive transpulmonary end-expiratory pressure to a control protocol. Respiratory system and transpulmonary driving pressures and pulmonary mechanics were examined at baseline, 5 min and 24 h. Analysis of variance and linear regression were used to compare 28 day survivors versus non-survivors and the intervention group versus the control group, respectively.Results: At baseline and 5 min there was no difference in respiratory system or transpulmonary driving pressure. By 24 h, survivors had lower respiratory system and transpulmonary driving pressures. Similarly, by 24 h the intervention group had lower transpulmonary driving pressure. This decrease was explained by improved elastance and increased PEEP.Conclusions: The results suggest that utilizing PEEP titration to target positive transpulmonary pressure via esophageal manometry causes both improved elastance and driving pressures. Treatment strategies leading to decreased respiratory system and transpulmonary driving pressure at 24 h may be associated with improved 28 day mortality. Studies to clarify the role of respiratory system and transpulmonary driving pressures as a prognosticator and bedside ventilator target are warranted. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of Intensive Care Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Abstract:
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