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Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Rationale: The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure. Objectives: To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in...

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Autores principales: Tonelli, Roberto, Fantini, Riccardo, Tabbì, Luca, Castaniere, Ivana, Pisani, Lara, Pellegrino, Maria Rosaria, Della Casa, Giovanni, D’Amico, Roberto, Girardis, Massimo, Nava, Stefano, Clini, Enrico M., Marchioni, Alessandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Thoracic Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427381/
https://www.ncbi.nlm.nih.gov/pubmed/32325004
http://dx.doi.org/10.1164/rccm.201912-2512OC
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author Tonelli, Roberto
Fantini, Riccardo
Tabbì, Luca
Castaniere, Ivana
Pisani, Lara
Pellegrino, Maria Rosaria
Della Casa, Giovanni
D’Amico, Roberto
Girardis, Massimo
Nava, Stefano
Clini, Enrico M.
Marchioni, Alessandro
author_facet Tonelli, Roberto
Fantini, Riccardo
Tabbì, Luca
Castaniere, Ivana
Pisani, Lara
Pellegrino, Maria Rosaria
Della Casa, Giovanni
D’Amico, Roberto
Girardis, Massimo
Nava, Stefano
Clini, Enrico M.
Marchioni, Alessandro
author_sort Tonelli, Roberto
collection PubMed
description Rationale: The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure. Objectives: To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Methods: Thirty consecutive patients with acute hypoxic de novo respiratory failure admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal change in esophageal pressure (ΔPes), tidal change in dynamic transpulmonary pressure (ΔPl), expiratory Vt, and respiratory rate were recorded on admission and 2–4 to 12–24 hours after NIV start and were tested for correlation with outcomes. Measurements and Main Results: ΔPes and ΔPes/ΔPl ratio were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (n = 18) compared with those who needed endotracheal intubation (n = 12) (median [interquartile range], 11 [8–15] cm H(2)O vs. 31.5 [30–36] cm H(2)O; P < 0.0001), whereas other variables differed later. ΔPes was not related to other predictors of NIV failure at baseline. NIV-induced reduction in ΔPes of 10 cm H(2)O or more after 2 hours of treatment was strongly associated with avoidance of intubation and represented the most accurate predictor of treatment success (odds ratio, 15; 95% confidence interval, 2.8–110; P = 0.001 and area under the curve, 0.97; 95% confidence interval, 0.91–1; P < 0.0001). Conclusions: The magnitude of inspiratory effort relief as assessed by ΔPes variation within the first 2 hours of NIV was an early and accurate predictor of NIV outcome at 24 hours. Clinical trial registered with www.clinicaltrials.gov (NCT 03826797).
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spelling pubmed-74273812020-08-17 Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study Tonelli, Roberto Fantini, Riccardo Tabbì, Luca Castaniere, Ivana Pisani, Lara Pellegrino, Maria Rosaria Della Casa, Giovanni D’Amico, Roberto Girardis, Massimo Nava, Stefano Clini, Enrico M. Marchioni, Alessandro Am J Respir Crit Care Med Original Articles Rationale: The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure. Objectives: To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Methods: Thirty consecutive patients with acute hypoxic de novo respiratory failure admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal change in esophageal pressure (ΔPes), tidal change in dynamic transpulmonary pressure (ΔPl), expiratory Vt, and respiratory rate were recorded on admission and 2–4 to 12–24 hours after NIV start and were tested for correlation with outcomes. Measurements and Main Results: ΔPes and ΔPes/ΔPl ratio were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (n = 18) compared with those who needed endotracheal intubation (n = 12) (median [interquartile range], 11 [8–15] cm H(2)O vs. 31.5 [30–36] cm H(2)O; P < 0.0001), whereas other variables differed later. ΔPes was not related to other predictors of NIV failure at baseline. NIV-induced reduction in ΔPes of 10 cm H(2)O or more after 2 hours of treatment was strongly associated with avoidance of intubation and represented the most accurate predictor of treatment success (odds ratio, 15; 95% confidence interval, 2.8–110; P = 0.001 and area under the curve, 0.97; 95% confidence interval, 0.91–1; P < 0.0001). Conclusions: The magnitude of inspiratory effort relief as assessed by ΔPes variation within the first 2 hours of NIV was an early and accurate predictor of NIV outcome at 24 hours. Clinical trial registered with www.clinicaltrials.gov (NCT 03826797). American Thoracic Society 2020-08-15 2020-08-15 /pmc/articles/PMC7427381/ /pubmed/32325004 http://dx.doi.org/10.1164/rccm.201912-2512OC Text en Copyright © 2020 by the American Thoracic Society https://creativecommons.org/licenses/by-nc-nd/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). For commercial usage and reprints, please contact Diane Gern (dgern@thoracic.org).
spellingShingle Original Articles
Tonelli, Roberto
Fantini, Riccardo
Tabbì, Luca
Castaniere, Ivana
Pisani, Lara
Pellegrino, Maria Rosaria
Della Casa, Giovanni
D’Amico, Roberto
Girardis, Massimo
Nava, Stefano
Clini, Enrico M.
Marchioni, Alessandro
Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title_full Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title_fullStr Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title_full_unstemmed Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title_short Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study
title_sort early inspiratory effort assessment by esophageal manometry predicts noninvasive ventilation outcome in de novo respiratory failure. a pilot study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427381/
https://www.ncbi.nlm.nih.gov/pubmed/32325004
http://dx.doi.org/10.1164/rccm.201912-2512OC
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