Purpose: An inspiratory hold during patient-triggered assisted ventilation potentially allows to measure driving pressure and inspiratory effort. However, muscular activity can make this measurement unreliable. We aim to define the criteria for inspiratory holds reliability during patient-triggered breaths. Material and methods: Flow, airway and esophageal pressure recordings during patient-triggered breaths from a multicentre observational study (BEARDS, NCT03447288) were evaluated by six independent raters, to determine plateau pressure readability. Features of “readable” and “unreadable” holds were compared. Muscle pressure estimate from the hold was validated against other measures of inspiratory effort. Results: Ninety-two percent of the recordings were consistently judged as readable or unreadable by at least four raters. Plateau measurement showed a high consistency among raters. A short time from airway peak to plateau pressure and a stable and longer plateau characterized readable holds. Unreadable plateaus were associated with higher indexes of inspiratory effort. Muscular pressure computed from the hold showed a strong correlation with independent indexes of inspiratory effort. Conclusion: The definition of objective parameters of plateau reliability during assisted-breath provides the clinician with a tool to target a safer assisted-ventilation and to detect the presence of high inspiratory effort.

Bianchi, I., Grassi, A., Pham, T., Telias, I., Teggia Droghi, M., Vieira, F., et al. (2022). Reliability of plateau pressure during patient-triggered assisted ventilation. Analysis of a multicentre database. JOURNAL OF CRITICAL CARE, 68(April 2022), 96-103 [10.1016/j.jcrc.2021.12.002].

Reliability of plateau pressure during patient-triggered assisted ventilation. Analysis of a multicentre database

Grassi A.
Secondo
;
Teggia Droghi M.;Bellani G.
Ultimo
2022

Abstract

Purpose: An inspiratory hold during patient-triggered assisted ventilation potentially allows to measure driving pressure and inspiratory effort. However, muscular activity can make this measurement unreliable. We aim to define the criteria for inspiratory holds reliability during patient-triggered breaths. Material and methods: Flow, airway and esophageal pressure recordings during patient-triggered breaths from a multicentre observational study (BEARDS, NCT03447288) were evaluated by six independent raters, to determine plateau pressure readability. Features of “readable” and “unreadable” holds were compared. Muscle pressure estimate from the hold was validated against other measures of inspiratory effort. Results: Ninety-two percent of the recordings were consistently judged as readable or unreadable by at least four raters. Plateau measurement showed a high consistency among raters. A short time from airway peak to plateau pressure and a stable and longer plateau characterized readable holds. Unreadable plateaus were associated with higher indexes of inspiratory effort. Muscular pressure computed from the hold showed a strong correlation with independent indexes of inspiratory effort. Conclusion: The definition of objective parameters of plateau reliability during assisted-breath provides the clinician with a tool to target a safer assisted-ventilation and to detect the presence of high inspiratory effort.
Articolo in rivista - Articolo scientifico
Driving pressure; Inspiratory effort; Inspiratory hold; Plateau pressure; Pressure support ventilation;
English
21-dic-2021
2022
68
April 2022
96
103
none
Bianchi, I., Grassi, A., Pham, T., Telias, I., Teggia Droghi, M., Vieira, F., et al. (2022). Reliability of plateau pressure during patient-triggered assisted ventilation. Analysis of a multicentre database. JOURNAL OF CRITICAL CARE, 68(April 2022), 96-103 [10.1016/j.jcrc.2021.12.002].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/342168
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