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Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients

BACKGROUND: High drive and high effort during spontaneous breathing can generate patient self-inflicted lung injury (P-SILI) due to uncontrolled high transpulmonary and transvascular pressures, with deterioration of respiratory failure. P-SILI has been demonstrated in experimental studies and suppor...

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Autores principales: Simón, José Manuel Serrano, Montosa, Carolina Joya, Carmona, Juan Francisco Martínez, Amaya, Manuel Jesús Delgado, Castro, Javier Luna, Carmona, Ashlen Rodríguez, Pérez, José Castaño, Delgado, Marina Rodríguez, Centeno, Guillermo Besso, Lozano, José Antonio Benítez
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492295/
https://www.ncbi.nlm.nih.gov/pubmed/37684557
http://dx.doi.org/10.1186/s12890-023-02631-0
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author Simón, José Manuel Serrano
Montosa, Carolina Joya
Carmona, Juan Francisco Martínez
Amaya, Manuel Jesús Delgado
Castro, Javier Luna
Carmona, Ashlen Rodríguez
Pérez, José Castaño
Delgado, Marina Rodríguez
Centeno, Guillermo Besso
Lozano, José Antonio Benítez
author_facet Simón, José Manuel Serrano
Montosa, Carolina Joya
Carmona, Juan Francisco Martínez
Amaya, Manuel Jesús Delgado
Castro, Javier Luna
Carmona, Ashlen Rodríguez
Pérez, José Castaño
Delgado, Marina Rodríguez
Centeno, Guillermo Besso
Lozano, José Antonio Benítez
author_sort Simón, José Manuel Serrano
collection PubMed
description BACKGROUND: High drive and high effort during spontaneous breathing can generate patient self-inflicted lung injury (P-SILI) due to uncontrolled high transpulmonary and transvascular pressures, with deterioration of respiratory failure. P-SILI has been demonstrated in experimental studies and supported in recent computational models. Different treatment strategies have been proposed according to the phenotype of elastance of the respiratory system (Ers) for patients with COVID-19. This study aimed to investigate the effect of three spontaneous ventilation modes on respiratory drive and muscle effort in clinical practice and their relationship with different phenotypes. This was achieved by obtaining the following respiratory signals: airway pressure (Paw), flow (V´) and volume (V) and calculating muscle pressure (Pmus). METHODS: A physiologic observational study of a series of cases in a university medical-surgical ICU involving 11 mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing was conducted. Three spontaneous ventilation modes were evaluated in each of the patients: pressure support ventilation (PSV), airway pressure release ventilation (APRV), and BiLevel positive airway pressure ventilation (BIPAP). Pmus was calculated through the equation of motion. For this purpose, we acquired the signals of Paw, V´ and V directly from the data transmission protocol of the ventilator (Dräger). The main physiological measurements were calculation of the respiratory drive (P0.1), muscle effort through the ΔPmus, pressure‒time product (PTP/min) and work of breathing of the patient in joules multiplied by respiratory frequency (WOBp, J/min). RESULTS: Ten mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing were evaluated. Our results showed similar high drive and muscle effort in each of the spontaneous ventilatory modes tested, without significant differences between them: median (IQR): P0.1 6.28 (4.92–7.44) cm H(2)O, ∆Pmus 13.48 (11.09–17.81) cm H(2)O, PTP 166.29 (124.02–253.33) cm H(2)O*sec/min, and WOBp 12.76 (7.46–18.04) J/min. High drive and effort were found in patients even with low Ers. There was a significant relationship between respiratory drive and WOBp and Ers, though the coefficient of variation widely varied. CONCLUSIONS: In our study, none of the spontaneous ventilatory methods tested succeeded in reducing high respiratory drive or muscle effort, regardless of the Ers, with subsequent risk of P-SILI.
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spelling pubmed-104922952023-09-10 Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients Simón, José Manuel Serrano Montosa, Carolina Joya Carmona, Juan Francisco Martínez Amaya, Manuel Jesús Delgado Castro, Javier Luna Carmona, Ashlen Rodríguez Pérez, José Castaño Delgado, Marina Rodríguez Centeno, Guillermo Besso Lozano, José Antonio Benítez BMC Pulm Med Research BACKGROUND: High drive and high effort during spontaneous breathing can generate patient self-inflicted lung injury (P-SILI) due to uncontrolled high transpulmonary and transvascular pressures, with deterioration of respiratory failure. P-SILI has been demonstrated in experimental studies and supported in recent computational models. Different treatment strategies have been proposed according to the phenotype of elastance of the respiratory system (Ers) for patients with COVID-19. This study aimed to investigate the effect of three spontaneous ventilation modes on respiratory drive and muscle effort in clinical practice and their relationship with different phenotypes. This was achieved by obtaining the following respiratory signals: airway pressure (Paw), flow (V´) and volume (V) and calculating muscle pressure (Pmus). METHODS: A physiologic observational study of a series of cases in a university medical-surgical ICU involving 11 mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing was conducted. Three spontaneous ventilation modes were evaluated in each of the patients: pressure support ventilation (PSV), airway pressure release ventilation (APRV), and BiLevel positive airway pressure ventilation (BIPAP). Pmus was calculated through the equation of motion. For this purpose, we acquired the signals of Paw, V´ and V directly from the data transmission protocol of the ventilator (Dräger). The main physiological measurements were calculation of the respiratory drive (P0.1), muscle effort through the ΔPmus, pressure‒time product (PTP/min) and work of breathing of the patient in joules multiplied by respiratory frequency (WOBp, J/min). RESULTS: Ten mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing were evaluated. Our results showed similar high drive and muscle effort in each of the spontaneous ventilatory modes tested, without significant differences between them: median (IQR): P0.1 6.28 (4.92–7.44) cm H(2)O, ∆Pmus 13.48 (11.09–17.81) cm H(2)O, PTP 166.29 (124.02–253.33) cm H(2)O*sec/min, and WOBp 12.76 (7.46–18.04) J/min. High drive and effort were found in patients even with low Ers. There was a significant relationship between respiratory drive and WOBp and Ers, though the coefficient of variation widely varied. CONCLUSIONS: In our study, none of the spontaneous ventilatory methods tested succeeded in reducing high respiratory drive or muscle effort, regardless of the Ers, with subsequent risk of P-SILI. BioMed Central 2023-09-08 /pmc/articles/PMC10492295/ /pubmed/37684557 http://dx.doi.org/10.1186/s12890-023-02631-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Simón, José Manuel Serrano
Montosa, Carolina Joya
Carmona, Juan Francisco Martínez
Amaya, Manuel Jesús Delgado
Castro, Javier Luna
Carmona, Ashlen Rodríguez
Pérez, José Castaño
Delgado, Marina Rodríguez
Centeno, Guillermo Besso
Lozano, José Antonio Benítez
Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title_full Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title_fullStr Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title_full_unstemmed Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title_short Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients
title_sort effects of three spontaneous ventilation modes on respiratory drive and muscle effort in covid-19 pneumonia patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492295/
https://www.ncbi.nlm.nih.gov/pubmed/37684557
http://dx.doi.org/10.1186/s12890-023-02631-0
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