Author:
Haudebourg Anne-Fleur,Moncomble Elsa,Lesimple Arnaud,Delamaire Flora,Louis Bruno,Mekontso Dessap Armand,Mercat Alain,Richard Jean-Christophe,Beloncle François,Carteaux Guillaume
Abstract
Abstract
Background
Airway opening pressure (AOP) detection and measurement are essential for assessing respiratory mechanics and adapting ventilation. We propose a novel approach for AOP assessment during volume assist control ventilation at a usual constant-flow rate of 60 L/min.
Objectives
To validate the conductive pressure (Pcond) method, which compare the Pcond—defined on the airway pressure waveform as the difference between the airway pressure level at which an abrupt change in slope occurs at the beginning of insufflation and PEEP—to resistive pressure for AOP detection and measurement, and to compare its respiratory and hemodynamic tolerance to the standard low-flow insufflation method.
Methods
The proof-of-concept of the Pcond method was assessed on mechanical (lung simulator) and physiological (cadavers) bench models. Its diagnostic performance was evaluated in 213 patients, using the standard low-flow insufflation method as a reference. In 45 patients, the respiratory and hemodynamic tolerance of the Pcond method was compared with the standard low-flow method.
Measurements and main results
Bench assessments validated the Pcond method proof-of-concept. Sensitivity and specificity of the Pcond method for AOP detection were 93% and 91%, respectively. AOP obtained by Pcond and standard low-flow methods strongly correlated (r = 0.84, p < 0.001). Changes in SpO2 were significantly lower during Pcond than during standard method (p < 0.001).
Conclusion
Determination of Pcond during constant-flow assist control ventilation may permit to easily and safely detect and measure AOP.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Cited by
2 articles.
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