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Transpulmonary Pressure-Guided Lung-Protective Ventilation Improves Pulmonary Mechanics and Oxygenation Among Obese Subjects on Mechanical Ventilation.

BACKGROUND: Transpulmonary pressure (PL) is used to assess pulmonary mechanics and guide lung-protective mechanical ventilation (LPV). PL is recommended to individualize LPV settings for patients with high pleural pressures and hypoxemia. We aimed to determine whether PL-guided LPV settings, pulmona...

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Published in:Respiratory Care Vol. 66; no. 7; pp. 1049 - 1059
Main Authors: Rowley, Daniel D., Arrington, Susan R., Enfield, Kyle B., Lamb, Keith D., Kadl, Alexandra, Davis, John P., Theodore, Danny J.
Format: CEU research tables/charts Journal Article
Published: Mary Ann Liebert, Inc. Jul2021
Online Access:View this record in EBSCOhost
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      dt: Jul2021
      vid: 66
      iid: 7
      pid: 1365
      pub: Mary Ann Liebert, Inc.
      place: New Rochelle, New York
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        10.4187/respcare.08686
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        atl: Transpulmonary Pressure-Guided Lung-Protective Ventilation Improves Pulmonary Mechanics and Oxygenation Among Obese Subjects on Mechanical Ventilation.
      aug:
        au:
          Rowley, Daniel D.
          Arrington, Susan R.
          Enfield, Kyle B.
          Lamb, Keith D.
          Kadl, Alexandra
          Davis, John P.
          Theodore, Danny J.
        affil: Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, Virginia
      sug:
        subj:
          Respiration, Artificial Methods
          Respiratory Mechanics Evaluation
          Oxygenation Evaluation
          Obesity
          Anoxemia Therapy
          Respiratory Distress Syndrome, Acute Therapy
          Treatment Outcomes
          Education, Continuing (Credit)
          Human
          Retrospective Design
          Male
          Female
          Adult
          Middle Age
          Descriptive Statistics
          Data Analysis Software
          Pretest-Posttest Design
          Wilcoxon Signed Rank Test
          McNemar's Test
          Repeated Measures
          Friedman Test
          Two-Way Analysis of Variance
          Comparative Studies
          Coefficient alpha
          Post Hoc Analysis
          Questionnaires
          Positive End-Expiratory Pressure
          Inspiration, Respiratory
          Expiration
          Intensive Care Units
          Inpatients
          Critically Ill Patients
          Length of Stay
          Hospital Mortality
          Respiratory Distress Syndrome, Acute Mortality
          Pressure Support Ventilation
          Academic Medical Centers
          Virginia
          Record Review
          Exploratory Research
          Prospective Studies
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Male
          Female
      ab: BACKGROUND: Transpulmonary pressure (PL) is used to assess pulmonary mechanics and guide lung-protective mechanical ventilation (LPV). PL is recommended to individualize LPV settings for patients with high pleural pressures and hypoxemia. We aimed to determine whether PL-guided LPV settings, pulmonary mechanics, and oxygenation improve and differ from non-PL-guided LPV among obese patients after 24 h on mechanical ventilation. Secondary outcomes included classification of hypoxemia severity, count of ventilator-free days, ICU length of stay, and overall ICU mortality. METHODS: This is a retrospective analysis of data. Ventilator settings, pulmonary mechanics, and oxygenation were recorded on the initial day of PL measurement and 24 h later. PL-guided LPV targeted inspiratory PL < 20 cm H2O and expiratory PL of 0--6 cm H2O. Comparisons were made to repeat measurements. RESULTS: Twenty subjects (13 male) with median age of 49 y, body mass index 47.5 kg/m², and SOFA score of 8 were included in our analysis. Fourteen subjects received care in a medical ICU. PL measurement occurred 16 h after initiating non-PL-guided LPV. PL-guided LPV resulted in higher median PEEP (14 vs 18 cm H2O, P = .009), expiratory PL (--3 vs 1 cm H2O, P = .02), respiratory system compliance (30.7 vs 44.6 mL/cm H2O, P = .001), and PaO2/FIO2 (156 vs 240 mm Hg, P = .002) at 24 h. PL-guided LPV resulted in lower FIO2 (0.53 vs 0.33, P < .001) and lower PL driving pressure (10 vs 6 cm H2O, P = .001). Tidal volume (420 vs 435 mL, P = .64) and inspiratory PL (7 vs 7 cm H2O, P = .90) were similar. Subjects had a median of 7 ventilator-free days, and median ICU length of stay was 14 d. Three of 20 subjects died within 28 d after ICU admission. CONCLUSIONS: PL-guided LPV resulted in higher PEEP, lower FIO2, improved pulmonary mechanics, and greater oxygenation when compared to non-PL-guided LPV settings in adult obese subjects. Key words: mechanical ventilation; obesity; respiratory mechanics; esophageal pressure;
      pubtype: Academic Journal
      doctype:
        CEU
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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