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Energy transmission in mechanically ventilated children: a translational study

BACKGROUND: Recurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how...

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Autores principales: Kneyber, Martin C. J., Ilia, Stavroula, Koopman, Alette A., van Schelven, Patrick, van Dijk, Jefta, Burgerhof, Johannes G. M., Markhorst, Dick G., Blokpoel, Robert G. T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539278/
https://www.ncbi.nlm.nih.gov/pubmed/33028370
http://dx.doi.org/10.1186/s13054-020-03313-7
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author Kneyber, Martin C. J.
Ilia, Stavroula
Koopman, Alette A.
van Schelven, Patrick
van Dijk, Jefta
Burgerhof, Johannes G. M.
Markhorst, Dick G.
Blokpoel, Robert G. T.
author_facet Kneyber, Martin C. J.
Ilia, Stavroula
Koopman, Alette A.
van Schelven, Patrick
van Dijk, Jefta
Burgerhof, Johannes G. M.
Markhorst, Dick G.
Blokpoel, Robert G. T.
author_sort Kneyber, Martin C. J.
collection PubMed
description BACKGROUND: Recurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how ME relates to underlying lung pathology and outcome in mechanically ventilated children. We therefore tested the hypothesis that ME per breath with tidal volume (Vt) normalized to bodyweight correlates with underlying lung pathology and to study the effect of resistance on the ME dissipated to the lung. METHODS: We analyzed routinely collected demographic, physiological, and laboratory data from deeply sedated and/or paralyzed children < 18 years with and without lung injury. Patients were stratified into respiratory system mechanic subgroups according to the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) definition. The association between MP, ME, lung pathology, and duration of mechanical ventilation as a primary outcome measure was analyzed adjusting for confounding variables and effect modifiers. The effect of endotracheal tube diameter (ETT) and airway resistance on energy dissipation to the lung was analyzed in a bench model with different lung compliance settings. RESULTS: Data of 312 patients with a median age of 7.8 (1.7–44.2) months was analyzed. Age (p <  0.001), RR p <  0.001), and Vt <  0.001) were independently associated with MPrs. ME but not MP correlated significantly (p <  0.001) better with lung pathology. Competing risk regression analysis adjusting for PRISM III 24 h score and PEMVECC stratification showed that ME on day 1 or day 2 of MV but not MP was independently associated with the duration of mechanical ventilation. About 33% of all energy generated by the ventilator was transferred to the lung and highly dependent on lung compliance and airway resistance but not on endotracheal tube size (ETT) during pressure control (PC) ventilation. CONCLUSIONS: ME better related to underlying lung pathology and patient outcome than MP. The delivery of generated energy to the lung was not dependent on ETT size during PC ventilation. Further studies are needed to identify injurious MErs thresholds in ventilated children.
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spelling pubmed-75392782020-10-07 Energy transmission in mechanically ventilated children: a translational study Kneyber, Martin C. J. Ilia, Stavroula Koopman, Alette A. van Schelven, Patrick van Dijk, Jefta Burgerhof, Johannes G. M. Markhorst, Dick G. Blokpoel, Robert G. T. Crit Care Research BACKGROUND: Recurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how ME relates to underlying lung pathology and outcome in mechanically ventilated children. We therefore tested the hypothesis that ME per breath with tidal volume (Vt) normalized to bodyweight correlates with underlying lung pathology and to study the effect of resistance on the ME dissipated to the lung. METHODS: We analyzed routinely collected demographic, physiological, and laboratory data from deeply sedated and/or paralyzed children < 18 years with and without lung injury. Patients were stratified into respiratory system mechanic subgroups according to the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) definition. The association between MP, ME, lung pathology, and duration of mechanical ventilation as a primary outcome measure was analyzed adjusting for confounding variables and effect modifiers. The effect of endotracheal tube diameter (ETT) and airway resistance on energy dissipation to the lung was analyzed in a bench model with different lung compliance settings. RESULTS: Data of 312 patients with a median age of 7.8 (1.7–44.2) months was analyzed. Age (p <  0.001), RR p <  0.001), and Vt <  0.001) were independently associated with MPrs. ME but not MP correlated significantly (p <  0.001) better with lung pathology. Competing risk regression analysis adjusting for PRISM III 24 h score and PEMVECC stratification showed that ME on day 1 or day 2 of MV but not MP was independently associated with the duration of mechanical ventilation. About 33% of all energy generated by the ventilator was transferred to the lung and highly dependent on lung compliance and airway resistance but not on endotracheal tube size (ETT) during pressure control (PC) ventilation. CONCLUSIONS: ME better related to underlying lung pathology and patient outcome than MP. The delivery of generated energy to the lung was not dependent on ETT size during PC ventilation. Further studies are needed to identify injurious MErs thresholds in ventilated children. BioMed Central 2020-10-07 /pmc/articles/PMC7539278/ /pubmed/33028370 http://dx.doi.org/10.1186/s13054-020-03313-7 Text en © The Author(s) 2020 Open AccessThis 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/. The Creative Commons Public Domain Dedication waiver (http://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
Kneyber, Martin C. J.
Ilia, Stavroula
Koopman, Alette A.
van Schelven, Patrick
van Dijk, Jefta
Burgerhof, Johannes G. M.
Markhorst, Dick G.
Blokpoel, Robert G. T.
Energy transmission in mechanically ventilated children: a translational study
title Energy transmission in mechanically ventilated children: a translational study
title_full Energy transmission in mechanically ventilated children: a translational study
title_fullStr Energy transmission in mechanically ventilated children: a translational study
title_full_unstemmed Energy transmission in mechanically ventilated children: a translational study
title_short Energy transmission in mechanically ventilated children: a translational study
title_sort energy transmission in mechanically ventilated children: a translational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539278/
https://www.ncbi.nlm.nih.gov/pubmed/33028370
http://dx.doi.org/10.1186/s13054-020-03313-7
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