1105: TRANSPULMONARY PRESSURE-GUIDED PEEP TITRATION FOR MECHANICAL VENTILATION IN THE OBESE

Ventilator trauma refers to complications of mechanical ventilation, which have an impact on morbidity and mortality. Two major forms of ventilator trauma may be distinguished—an acute form related to rupture of airspaces causing air-leak syndrome and a subacute form causing protracted inflammatory responses. A key feature of mechanically-ventilated lungs is the presence of non-aerated and unstable regions due to atelectasis, oedema, or consolidation. Because of mechanical interdependence, pressures acting in non-uniformly expanded lungs at the boundaries between non-aerated and aerated lung may be a multiple of the apparent transpulmonary pressure. The resulting effects have been reported to precipitate or contribute to ventilator-induced lung injury (VILI). The engineering terms stress and strain were recently proposed for better definition of risk-constellations for VILI. Because the aerated lung volume is positively correlated to compliance, driving-pressure can aid in identifying disproportionate combinations of tidal volumes and compliance.

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Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation

Critical Care Medicine ◽

10.1097/ccm.0000000000004632 ◽

2020 ◽

Vol 48 (12) ◽

pp. e1379-e1380

Author(s):

Taku Furukawa ◽

Yudai Iwasaki ◽

Alan Kawarai Lefor ◽

Masamitsu Sanui

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Transpulmonary Pressure ◽

Ventilation Strategy ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation

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Is Continuous Transpulmonary Pressure Better Than Conventional Respiratory Management of Hyaline Membrane Disease? A Controlled Study

PEDIATRICS ◽

10.1542/peds.58.6.800 ◽

1976 ◽

Vol 58 (6) ◽

pp. 800-808

Author(s):

David A. Belenky ◽

Rosemary J. Orr ◽

David E. Woodrum ◽

W. Alan Hodson

Keyword(s):

Mechanical Ventilation ◽

Transpulmonary Pressure ◽

Hyaline Membrane Disease ◽

Controlled Study ◽

Complication Rates ◽

Control Groups ◽

Respiratory Management ◽

Significant Difference ◽

Hyaline Membrane ◽

And Control

The influence of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) on mortality and complication rates in severe hyaline membrane disease (HMD) was evaluated in a randomized, prospective study. Patients were admitted to the study if the PO2 was ≤ 50 mm Hg with FiO2 ≥ 0.6. Twenty-four patients in each of three weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6 to 14 cm H2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea or hypercapnia (PCO2 ≥ 65 mm Hg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or PO2 ≤ 50 mm Hg with FiO2 ≥ 0.8. Oxygenation improved after the start of CPAP or PEEP; however, PCO2 rose after CPAP was initiated. There was no significant difference between treatment and control groups in mortality, requirement for mechanical ventilation, or incidence of pulmonary sequelae. The incidence of pulmonary air-leak was increased with PEEP. The findings suggest that CPAP and PEEP have not significantly altered the outcome of HMD.

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Transpulmonary Pressure-Guided Lung-Protective Ventilation Improves Pulmonary Mechanics and Oxygenation Among Obese Subjects on Mechanical Ventilation

Respiratory Care ◽

10.4187/respcare.08686 ◽

2021 ◽

pp. respcare.08686

Author(s):

Daniel D Rowley ◽

Susan R Arrington ◽

Kyle B Enfield ◽

Keith D Lamb ◽

Alexandra Kadl ◽

...

Keyword(s):

Mechanical Ventilation ◽

Transpulmonary Pressure ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Pulmonary Mechanics ◽

Obese Subjects

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PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

Frontiers in Medicine ◽

10.3389/fmed.2021.745164 ◽

2021 ◽

Vol 8 ◽

Author(s):

Longxiang Su ◽

Pan Pan ◽

Huaiwu He ◽

Dawei Liu ◽

Yun Long

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Heart Function ◽

Transpulmonary Pressure ◽

Right Heart ◽

Right Heart Function ◽

Starting Point ◽

Respiratory Treatment ◽

The Right ◽

Right Ventricular Preload

Pulse pressure variation (PPV) is a mandatory index for hemodynamic monitoring during mechanical ventilation. The changes in pleural pressure (Ppl) and transpulmonary pressure (PL) caused by mechanical ventilation are the basis for PPV and lead to the effect of blood flow. If the state of hypovolemia exists, the effect of the increased Ppl during mechanical ventilation on the right ventricular preload will mainly affect the cardiac output, resulting in a positive PPV. However, PL is more influenced by the change in alveolar pressure, which produces an increase in right heart overload, resulting in high PPV. In particular, if spontaneous breathing is strong, the transvascular pressure will be extremely high, which may lead to the promotion of alveolar flooding and increased RV flow. Asynchronous breathing and mediastinal swing may damage the pulmonary circulation and right heart function. Therefore, according to the principle of PPV, a high PPV can be incorporated into the whole respiratory treatment process to monitor the mechanical ventilation cycle damage/protection regardless of the controlled ventilation or spontaneous breathing. Through the monitoring of PPV, the circulation-protective ventilation can be guided at bedside in real time by PPV.

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