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Positive end-expiratory pressure limits inspiratory effort through modulation of the effort-to-drive ratio: an experimental crossover study.
Widing, Hannes; Pellegrini, Mariangela; Chiodaroli, Elena; Persson, Per; Hallén, Katarina; Perchiazzi, Gaetano.
Afiliación
  • Widing H; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Ing 40, 3 tr, 751 85, Uppsala, Sweden. hannes.widing@outlook.com.
  • Pellegrini M; Department of Anesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. hannes.widing@outlook.com.
  • Chiodaroli E; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Ing 40, 3 tr, 751 85, Uppsala, Sweden.
  • Persson P; Department of Anesthesia, Operation, and Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
  • Hallén K; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Ing 40, 3 tr, 751 85, Uppsala, Sweden.
  • Perchiazzi G; Anesthesia and Intensive Care Medicine, Polo Universitario San Paolo, University of Milan, Milan, Italy.
Intensive Care Med Exp ; 12(1): 10, 2024 Feb 05.
Article en En | MEDLINE | ID: mdl-38311676
ABSTRACT

BACKGROUND:

How assisted spontaneous breathing should be used during acute respiratory distress syndrome is questioned. Recent evidence suggests that high positive end-expiratory pressure (PEEP) may limit the risk of patient self-inflicted lung injury (P-SILI). The aim of this study was to assess the effects of PEEP on esophageal pressure swings, inspiratory drive, and the neuromuscular efficiency of ventilation. We hypothesized that high PEEP would reduce esophageal pressure swings, regardless of inspiratory drive changes, by modulating the effort-to-drive ratio (EDR). This was tested retrospectively in an experimental animal crossover study. Anesthetized pigs (n = 15) were subjected to mild to moderate lung injury and different PEEP levels were applied, changing PEEP from 0 to 15 cmH2O and back to 0 cmH2O in steps of 3 cmH2O. Airway pressure, esophageal pressure (Pes), and electric activity of the diaphragm (Edi) were collected. The EDR was calculated as the tidal change in Pes divided by the tidal change in Edi. Statistical differences were tested using the Wilcoxon signed-rank test.

RESULTS:

Inspiratory esophageal pressure swings decreased from - 4.2 ± 3.1 cmH2O to - 1.9 ± 1.5 cmH2O (p < 0.01), and the mean EDR fell from - 1.12 ± 1.05 cmH2O/µV to - 0.24 ± 0.20 (p < 0.01) as PEEP was increased from 0 to 15 cmH2O. The EDR was significantly correlated to the PEEP level (rs = 0.35, p < 0.01).

CONCLUSIONS:

Higher PEEP limits inspiratory effort by modulating the EDR of the respiratory system. These findings indicate that PEEP may be used in titration of the spontaneous impact on ventilation and in P-SILI risk reduction, potentially facilitating safe assisted spontaneous breathing. Similarly, ventilation may be shifted from highly spontaneous to predominantly controlled ventilation using PEEP. These findings need to be confirmed in clinical settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Intensive Care Med Exp Año: 2024 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Intensive Care Med Exp Año: 2024 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Alemania