Publish in this journal
Journal Information
Vol. 43. Num. 4.
Pages 193-260 (May 2019)
Share
Share
Download PDF
More article options
ePub
Visits
17
Vol. 43. Num. 4.
Pages 193-260 (May 2019)
Original
DOI: 10.1016/j.medine.2019.03.001
Conventional monitoring is not sufficient to assess respiratory effort during assisted ventilation
La monitorización convencional no es suficiente para valorar el esfuerzo respiratorio durante la ventilación asistida
Visits
17
F. Ruiz Ferróna,
Corresponding author
fruizferron@gmail.com

Corresponding author.
, J.M. Serrano Simónb
a Unidad de Cuidados Intensivos, Hospital Universitario San Cecilio, Granada, Spain
b Unidad de Cuidados Intensivos, Hospital Reina Sofía, Córdoba, Spain
This item has received
17
Visits
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Tables (3)
Table 1. Characteristics of the patients, respiratory mechanics and prognosis.
Table 2. Variables referred to effort measured in all data, assist 100% (ACV1 and PS1) and assist ≤50% (CPAP, PS5, ACV5).
Table 3. Descriptive statistics and concordance.
Show moreShow less
Abstract
Objective

Study the relationship and concordance between calculated respiratory effort using the signals of the ventilator (Pmus) and that measured in esophageal pressure (Pes) on mechanical ventilation with different levels of respiratory assistance.

Design

Prospective cohort study.

Ambit

Intensive Care Unit of 2 universitary hospitals.

Patients

Patients on weaning time.

Procedure

Airway, esophageal and respiratory flow were recorded on CPAP, assist volume control (ACV) and pressure support (PS), with complete (ACV1, PS1) and partial assistance (ACV5, PS5). Measurement: respiratory variations of Pes and Pmus (Δ: cmH2O) and pressure time product (PTPm: cmH2O·s/m).

Results

Fourty one records were studied, the assistance was in CPAP of 5cmH2O, PS1 of 15±5 reduced to 9±4cmH2O. In ACV1 the inspiratory flow was 1±0.2l/s, reduced to 0.49±0.1l/s for ACV5. The increase in respiratory assistance decreases respiratory effort, measured in Delta Pes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 and in Pmus 16±5, 10±6, 5±3, 10±6, 5±4cmH2O (p<.001). The PTP per minute measured in Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (p=.001) and in Pmus: 293±117, 156±84, 24±32, 233±121, 79±90 (p<.001). The measurements in Pes and Pmus showed the following correlation, in Delta: 0.72 and PTPm, 0.87. The Bland–Altman analysis indicates that the difference between Delta Pes-Pmus can be 16 and the PTPm of 264 and the systematic error in Delta: −0.98±4.4 and PTPm −23.69±66.3cmH2O·s/m.

Conclusions

Calculated and measured parameters of respiratory effort showed unacceptable differences in clinical practice.

Keywords:
Mechanical ventilation
Respiratory work of breathing
Respiratory mechanics
Resumen
Objetivo

Analizar la relación y concordancia entre el esfuerzo respiratorio calculado con las señales del respirador (Pmus) y el medido con presión esofágica (Pes), en ventilación mecánica con diferentes niveles de asistencia respiratoria.

Diseño

Estudio prospectivo de una cohorte.

Ámbito

Unidad de cuidados intensivos polivalente en 2 hospitales terciarios.

Pacientes

Pacientes en fase de retirada de la ventilación mecánica.

Intervenciones

La presión en la vía aérea, esofágica y flujo respiratorio se registraron en CPAP, ventilación asistida controlada por volumen (ACV) y presión soporte (PS) con asistencia respiratoria completa (ACV1, PS1) y parcial (ACV5, PS5). Variables medidas en Pes y Pmus: amplitud respiratoria (Δ: cmH2O) y el producto presión tiempo por minuto (PTPm: cmH2O·s/m).

Resultados

En 10 pacientes se estudiaron 41 registros. La asistencia en CPAP fue de 5cmH2O, PS1 15±5 y PS54cmH2O. En ACV1 el flujo inspiratorio fue 1±0,2l/s, reducido a 0,49±0,1l/s para ACV5. El esfuerzo respiratorio disminuyó con el aumento de la asistencia respiratoria: ΔPes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 y en ΔPmus 16±5, 10±6, 5±3, 10±6, 5±4cmH2O (p<0,001). PTPm Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (p=0,001) y en Pmus: 293±117, 156±84, 24±32, 233±121, 79±90cmH2O·s/m (p<0,001). Las medidas en Pes y Pmus mostraron una correlación Δ:0,72 y PTPm: 0,87. El análisis de Bland–Altman demostró que la diferencia ΔPes-Pmus puede ser de 16cmH2O y el PTPm de 264 y el error sistemático en Δ: −0,98±4,4 y PTPm −23,69±66,3cmH2O·s/m.

Conclusiones

Los parámetros calculados de esfuerzo respiratorio y los medidos directamente presentan diferencias que no son aceptables en la práctica clínica.

Palabras clave:
Ventilación mecánica
Trabajo respiratorio
Mecánica respiratoria

Article

These are the options to access the full texts of the publication Medicina Intensiva (English Edition)
Member
If you are a member of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias::
Go to the members area of the website of the SEMICYUC (www.semicyuc.org )and click the link to the magazine.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Medicina Intensiva (English Edition)

Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
902 88 87 40
Calls from outside Spain
+34 932 418 800
Email
Idiomas
Medicina Intensiva (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.