Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study.
Catheterization
/ methods
Central Venous Pressure
/ physiology
Diaphragm
/ pathology
Esophagus
/ pathology
Female
Heart Rate
Humans
Infant
Lung
/ pathology
Male
Pilot Projects
Pleural Cavity
/ physiology
Positive-Pressure Respiration
/ methods
Pressure
Prospective Studies
Respiration
Respiration, Artificial
/ adverse effects
Respiratory Mechanics
Vital Signs
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
30
06
2020
accepted:
05
02
2021
entrez:
1
3
2021
pubmed:
2
3
2021
medline:
8
9
2021
Statut:
epublish
Résumé
It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, - -2.6 ± 1.4, and - -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.
Sections du résumé
BACKGROUND
It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation.
METHODS
The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test.
RESULTS
Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, - -2.6 ± 1.4, and - -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001).
CONCLUSIONS
ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.
Identifiants
pubmed: 33647041
doi: 10.1371/journal.pone.0247360
pii: PONE-D-20-20085
pmc: PMC7920368
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0247360Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Clin Monit Comput. 2020 Aug;34(4):725-731
pubmed: 31346899
Am J Respir Crit Care Med. 2004 Feb 1;169(3):336-41
pubmed: 14739134
J Appl Physiol (1985). 1992 Jan;72(1):383-8
pubmed: 1537739
Minerva Anestesiol. 2020 Dec;86(12):1296-1304
pubmed: 32755084
J Crit Care. 2017 Feb;37:65-71
pubmed: 27636673
J Appl Physiol Respir Environ Exerc Physiol. 1980 Oct;49(4):735-42
pubmed: 7440288
Intensive Care Med. 2020 Jun;46(6):1099-1102
pubmed: 32291463
Eur Respir J. 1988 Jan;1(1):51-7
pubmed: 3366236
Chest. 2002 Feb;121(2):533-8
pubmed: 11834669
J Appl Physiol Respir Environ Exerc Physiol. 1982 Feb;52(2):491-4
pubmed: 7061304
Curr Opin Crit Care. 2019 Apr;25(2):192-198
pubmed: 30720482
Respir Physiol. 1977 Sep;31(1):63-70
pubmed: 918412
Anesthesiology. 2019 Apr;130(4):620-633
pubmed: 30844950
Am J Respir Crit Care Med. 2017 Feb 15;195(4):438-442
pubmed: 27626833
Ann Transl Med. 2018 Oct;6(19):377
pubmed: 30460251
Am Rev Respir Dis. 1982 Nov;126(5):788-91
pubmed: 7149443
J Appl Physiol (1985). 1987 Jan;62(1):315-21
pubmed: 3558190
Minerva Anestesiol. 2012 Aug;78(8):959-66
pubmed: 22699701
Am J Respir Crit Care Med. 2018 Jan 15;197(2):204-213
pubmed: 28930478
Crit Care Med. 1983 Apr;11(4):271-5
pubmed: 6831897
JAMA. 2016 Feb 23;315(8):788-800
pubmed: 26903337
Br J Anaesth. 1976 May;48(5):475-9
pubmed: 1276021
J Appl Physiol. 1964 Mar;19:207-11
pubmed: 14155283
Ups J Med Sci. 1976;81(1):49-53
pubmed: 1273999
Am J Respir Crit Care Med. 2020 Jan 1;201(1):20-32
pubmed: 31437406
Front Psychol. 2017 Apr 07;8:456
pubmed: 28439244
J Appl Physiol Respir Environ Exerc Physiol. 1983 Aug;55(2):353-8
pubmed: 6618927
Crit Care. 2019 Nov 6;23(1):346
pubmed: 31694692
Intensive Care Med. 2007 Nov;33(11):2004-8
pubmed: 17762930
Intensive Care Med. 2016 Sep;42(9):1360-73
pubmed: 27334266