RT Journal Article
SR Electronic
T1 Is airway driving pressure a good predictor of lung stress during mechanical ventilation for ARDS?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA3562
DO 10.1183/13993003.congress-2016.PA3562
VO 48
IS suppl 60
A1 Chiumello, Davide
A1 Brioni, Matteo
A1 Carlesso, Eleonora
A1 Colombo, Andrea
A1 Crimella, Francesco
A1 Cressoni, Massimo
YR 2016
UL https://publications.ersnet.org//content/48/suppl_60/PA3562.abstract
AB Background: In ARDS, mechanical ventilation is a fundamental supportive therapy, but can also trigger/increase lung inflammation, applying unphysiologic stress and strain to the parenchyma, leading to increased mortality. Lung protective strategies, limiting tidal volume (Vt) and plateau pressure (Pplat), have been proposed, but they are poor surrogates of stress/strain (Chiumello D et al, AJRCCM 2008:178:346-55). Recently, airway driving pressure (ΔP =Vt/Crs [respiratory system's compliance], or Pplat-PEEP) has been proposed as the key ventilatory variable associated with survival in ARDS (Amato MB et al, NEJM 2015:372:747-55).Objective: To assess if ΔP could accurately predict unsafe lung stress during mechanical ventilation in ARDS patients.Methods: 150 ARDS patients, deeply sedated and paralyzed, were ventilated with Vt of 6-8 mL/kg during a PEEP trial. ΔP and lung stress were measured at PEEP 5 and 15 cmH2O. Relationship between ΔP and lung stress was assessed by linear regression. Receiver operating characteristic (ROC) curve was used to verify the accuracy of ΔP in detecting a lung stress above safety threshold, defined at 24 cmH2O.Results: ΔP was significantly related to lung stress, both at PEEP 5 cmH2O (r2=0.581 p<0.0001) and 15 cmH2O (r2=0.353 p<0.0001). At PEEP 5 cmH2O none of the patients had a lung stress above 24 cmH2O. At PEEP 15 cmH2O, ΔP was a good predictor of a lung stress above 24 cmH2O, with 15 cmH2O as optimal cutoff (sensitivity 0.90, specificity 0.78; PPV 0.80, NPV 0.88; ROC area 0.85, 95%CI = 0.782–0.922).Conclusions: At PEEP 15 cmH2O, ΔP above 15 cmH2O predict unsafe lung stress, suggesting alternative approaches to support patient's respiratory function.