Dataset Information

Non-invasive method to detect high respiratory effort and transpulmonary driving pressures in COVID-19 patients during mechanical ventilation.

ABSTRACT:

Background

High respiratory drive in mechanically ventilated patients with spontaneous breathing effort may cause excessive lung stress and strain and muscle loading. Therefore, it is important to have a reliable estimate of respiratory effort to guarantee lung and diaphragm protective mechanical ventilation. Recently, a novel non-invasive method was found to detect excessive dynamic transpulmonary driving pressure (?P_L) and respiratory muscle pressure (P_mus) with reasonable accuracy. During the Coronavirus disease 2019 (COVID-19) pandemic, it was impossible to obtain the gold standard for respiratory effort, esophageal manometry, in every patient. Therefore, we investigated whether this novel non-invasive method could also be applied in COVID-19 patients.

Methods

?P_L and P_mus were derived from esophageal manometry in COVID-19 patients. In addition, ?P_L and P_mus were computed from the occlusion pressure (?P_occ) obtained during an expiratory occlusion maneuver. Measured and computed ?P_L and P_mus were compared and discriminative performance for excessive ?P_L and P_mus was assessed. The relation between occlusion pressure and respiratory effort was also assessed.

Results

Thirteen patients were included. Patients had a low dynamic lung compliance [24 (20-31) mL/cmH₂O], high ?P_L (25?±?6 cmH₂O) and high P_mus (16?±?7 cmH₂O). Low agreement was found between measured and computed ?P_L and P_mus. Excessive ?P_L?>?20 cmH₂O and P_mus?>?15 cmH₂O were accurately detected (area under the receiver operating curve (AUROC) 1.00 [95% confidence interval (CI), 1.00-1.00], sensitivity 100% (95% CI, 72-100%) and specificity 100% (95% CI, 16-100%) and AUROC 0.98 (95% CI, 0.90-1.00), sensitivity 100% (95% CI, 54-100%) and specificity 86% (95% CI, 42-100%), respectively). Respiratory effort calculated per minute was highly correlated with ?P_occ (for esophageal pressure time product per minute (PTP_es/min) r²?=?0.73; P?=?0.0002 and work of breathing (WOB) r²?=?0.85; P?Conclusions?P_L and P_mus can be computed from an expiratory occlusion maneuver and can predict excessive ?P_L and P_mus in patients with COVID-19 with high accuracy.

SUBMITTER: Roesthuis L

PROVIDER: S-EPMC7868882 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Non-invasive method to detect high respiratory effort and transpulmonary driving pressures in COVID-19 patients during mechanical ventilation.

Roesthuis Lisanne L van den Berg Maarten M van der Hoeven Hans H

Annals of intensive care 20210208 1

<h4>Background</h4>High respiratory drive in mechanically ventilated patients with spontaneous breathing effort may cause excessive lung stress and strain and muscle loading. Therefore, it is important to have a reliable estimate of respiratory effort to guarantee lung and diaphragm protective mechanical ventilation. Recently, a novel non-invasive method was found to detect excessive dynamic transpulmonary driving pressure (∆P<sub>L</sub>) and respiratory muscle pressure (P<sub>mus</sub>) with r ...[more]

PMID: 33555520

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Dataset Information

Non-invasive method to detect high respiratory effort and transpulmonary driving pressures in COVID-19 patients during mechanical ventilation.

Background

Methods

Results

Publications

Non-invasive method to detect high respiratory effort and transpulmonary driving pressures in COVID-19 patients during mechanical ventilation.

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