Effect of Endotracheal Tube Size, Respiratory System Mechanics, and Ventilator Settings on Driving Pressure.
Pediatr Crit Care Med
; 21(1): e47-e51, 2020 01.
Article
en En
| MEDLINE
| ID: mdl-31688716
ABSTRACT
OBJECTIVES:
We sought to investigate factors that affect the difference between the peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions (resistive pressure) during pressure controlled ventilation across a range of endotracheal tube sizes, respiratory mechanics, and ventilator settings.DESIGN:
In vitro study.SETTING:
Research laboratory. PATIENTS None.INTERVENTIONS:
An in vitro bench model of the intubated respiratory system during pressure controlled ventilation was used to obtain the difference between peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions across a range of endotracheal tubes sizes (3.0-8.0 mm). Measurements were taken at combinations of pressure above positive end-expiratory pressure (10, 15, and 20 cm H2O), airway resistance (no, low, high), respiratory system compliance (ranging from normal to extremely severe), and inspiratory time at constant positive end-expiratory pressure (5 cm H2O). Multiple regression analysis was used to construct models predicting resistive pressure stratified by endotracheal tube size. MEASUREMENTS AND MAINRESULTS:
On univariate regression analysis, respiratory system compliance (ß -1.5; 95% CI, -1.7 to -1.4; p < 0.001), respiratory system resistance (ß 1.7; 95% CI, 1.5-2.0; p < 0.001), pressure above positive end-expiratory pressure (ß 1.7; 95% CI, 1.4-2.0; p < 0.001), and inspiratory time (ß -0.7; 95% CI, -1.0 to -0.4; p < 0.001) were associated with resistive pressure. Multiple linear regression analysis showed the independent association between increasing respiratory system compliance, increasing airway resistance, increasing pressure above positive end-expiratory pressure, and decreasing inspiratory time and resistive pressure across all endotracheal tube sizes. Inspiratory time was the strongest variable associated with a proportional increase in resistive pressure. The contribution of airway resistance became more prominent with increasing endotracheal tube size.CONCLUSIONS:
Peak inspiratory pressures measured during pressure controlled ventilation overestimated plateau pressure irrespective of endotracheal tube size, especially with decreased inspiratory time or increased airway resistance.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Respiración Artificial
/
Mecánica Respiratoria
/
Respiración con Presión Positiva
/
Intubación Intratraqueal
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Pediatr Crit Care Med
Asunto de la revista:
PEDIATRIA
/
TERAPIA INTENSIVA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Países Bajos