The assessment of transpulmonary pressure in mechanically ventilated ARDS patients.
Intensive Care Med
; 40(11): 1670-8, 2014 Nov.
Article
em En
| MEDLINE
| ID: mdl-25112501
ABSTRACT
PURPOSE:
The optimal method for estimating transpulmonary pressure (i.e. the fraction of the airway pressure transmitted to the lung) has not yet been established.METHODS:
In this study on 44 patients with acute respiratory distress syndrome (ARDS), we computed the end-inspiratory transpulmonary pressure as the change in airway and esophageal pressure from end-inspiration to atmospheric pressure (i.e. release derived) and as the product of the end-inspiratory airway pressure and the ratio of lung to respiratory system elastance (i.e. elastance derived). The end-expiratory transpulmonary pressure was estimated as the product of positive end-expiratory pressure (PEEP) minus the direct measurement of esophageal pressure and by the release method.RESULTS:
The mean elastance- and release-derived transpulmonary pressure were 14.4 ± 3.7 and 14.4 ± 3.8 cmH2O at 5 cmH2O of PEEP and 21.8 ± 5.1 and 21.8 ± 4.9 cmH2O at 15 cmH2O of PEEP, respectively (P = 0.32, P = 0.98, respectively), indicating that these parameters were significantly related (r(2) = 0.98, P < 0.001 at 5 cmH2O of PEEP; r(2) = 0.93, P < 0.001 at 15 cmH2O of PEEP). The percentage error was 5.6 and 12.0 %, respectively. The mean directly measured and release-derived transpulmonary pressure were -8.0 ± 3.8 and 3.9 ± 0.9 cmH2O at 5 cmH2O of PEEP and -1.2 ± 3.2 and 10.6 ± 2.2 cmH2O at 15 cmH2O of PEEP, respectively, indicating that these parameters were not related (r(2) = 0.07, P = 0.08 at 5 cmH2O of PEEP; r (2) = 0.10, P = 0.53 at 15 cmH2O of PEEP).CONCLUSIONS:
Based on our observations, elastance-derived transpulmonary pressure can be considered to be an adequate surrogate of the release-derived transpulmonary pressure, while the release-derived and directly measured end-expiratory transpulmonary pressure are not related.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndrome do Desconforto Respiratório
/
Respiração com Pressão Positiva
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Pulmão
Limite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Intensive Care Med
Ano de publicação:
2014
Tipo de documento:
Article