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Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation
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Mistry, Sonal, Das, Anup, Saffaran, Sina, Yehya, Nadir, Scott, Timothy E., Chikhani, Marc, Laffey, John G., Hardman, Jonathan G., Camporota, Luigi and Bates, Declan G. (2022) Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation. Respiratory Research, 23 (1). 101. doi:10.1186/s12931-022-01985-z ISSN 1465-993X.
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Official URL: https://doi.org/10.1186/s12931-022-01985-z
Abstract
Background:
Airway pressure release ventilation (APRV) is widely available on mechanical ventilators and has been proposed as an early intervention to prevent lung injury or as a rescue therapy in the management of refractory hypoxemia. Driving pressure (ΔP) has been identified in numerous studies as a key indicator of ventilator-induced-lung-injury that needs to be carefully controlled. ΔP delivered by the ventilator in APRV is not directly measurable in dynamic conditions, and there is no “gold standard” method for its estimation.
Methods:
We used a computational simulator matched to data from 90 patients with acute respiratory distress syndrome (ARDS) to evaluate the accuracy of three “at-the-bedside” methods for estimating ventilator ΔP during APRV.
Results:
Levels of ΔP delivered by the ventilator in APRV were generally within safe limits, but in some cases exceeded levels specified by protective ventilation strategies. A formula based on estimating the intrinsic positive end expiratory pressure present at the end of the APRV release provided the most accurate estimates of ΔP. A second formula based on assuming that expiratory flow, volume and pressure decay mono-exponentially, and a third method that requires temporarily switching to volume-controlled ventilation, also provided accurate estimates of true ΔP.
Conclusions:
Levels of ΔP delivered by the ventilator during APRV can potentially exceed levels specified by standard protective ventilation strategies, highlighting the need for careful monitoring. Our results show that ΔP delivered by the ventilator during APRV can be accurately estimated at the bedside using simple formulae that are based on readily available measurements.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Engineering > Engineering | ||||||
| SWORD Depositor: | Library Publications Router | ||||||
| Library of Congress Subject Headings (LCSH): | Artificial respiration, Respiratory distress syndrome, Adult -- Treatment -- Computer simulation, Lungs -- Wounds and injuries -- Prevention | ||||||
| Journal or Publication Title: | Respiratory Research | ||||||
| Publisher: | BioMed Central | ||||||
| ISSN: | 1465-993X | ||||||
| Official Date: | 26 April 2022 | ||||||
| Dates: |
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| Volume: | 23 | ||||||
| Number: | 1 | ||||||
| Article Number: | 101 | ||||||
| DOI: | 10.1186/s12931-022-01985-z | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 20 May 2022 | ||||||
| Date of first compliant Open Access: | 23 May 2022 | ||||||
| RIOXX Funder/Project Grant: |
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