Lung and chest wall mechanics in patients with acute respiratory distress syndrome, expiratory flow limitation, and airway closure

2020 ◽  
Vol 128 (6) ◽  
pp. 1594-1603 ◽  
Author(s):  
Claude Guérin ◽  
Nicolas Terzi ◽  
Louis-Marie Galerneau ◽  
Mehdi Mezidi ◽  
Hodane Yonis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Distress Syndrome ◽  
Flow Limitation ◽  
Airway Closure ◽  
Positive End Expiratory Pressure ◽  
Expiratory Flow Limitation ◽  
Lung Elastance ◽  
Chest Wall Mechanics ◽  
Expiratory Flow ◽  
Better Than

Expiratory flow limitation (EFL) and airway closure (AC) were observed in 32% and 52%, respectively, of 25 patients with ARDS investigated during mechanical ventilation in supine position with a positive end-expiratory pressure of 5 cmH2O. The performance of dynamic lung elastance to detect expiratory flow limitation was good and better than that to detect airway closure. The vast majority of patients with EFL also had AC; however, AC can occur in the absence of EFL.

scholarly journals Airway Closure and Expiratory Flow Limitation in Acute Respiratory Distress Syndrome

2022 ◽  
Vol 12 ◽  
Author(s):  
Claude Guérin ◽  
Martin Cour ◽  
Laurent Argaud
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Flow Limitation ◽  
Airway Closure ◽  
Opening Pressure ◽  
Expiratory Flow Limitation ◽  
Airway Opening ◽  
Expiratory Flow

Acute respiratory distress syndrome (ARDS) is mostly characterized by the loss of aerated lung volume associated with an increase in lung tissue and intense and complex lung inflammation. ARDS has long been associated with the histological pattern of diffuse alveolar damage (DAD). However, DAD is not the unique pathological figure in ARDS and it can also be observed in settings other than ARDS. In the coronavirus disease 2019 (COVID-19) related ARDS, the impairment of lung microvasculature has been pointed out. The airways, and of notice the small peripheral airways, may contribute to the loss of aeration observed in ARDS. High-resolution lung imaging techniques found that in specific experimental conditions small airway closure was a reality. Furthermore, low-volume ventilator-induced lung injury, also called as atelectrauma, should involve the airways. Atelectrauma is one of the basic tenet subtending the use of positive end-expiratory pressure (PEEP) set at the ventilator in ARDS. Recent data revisited the role of airways in humans with ARDS and provided findings consistent with the expiratory flow limitation and airway closure in a substantial number of patients with ARDS. We discussed the pattern of airway opening pressure disclosed in the inspiratory volume-pressure curves in COVID-19 and in non-COVID-19 related ARDS. In addition, we discussed the functional interplay between airway opening pressure and expiratory flow limitation displayed in the flow-volume curves. We discussed the individualization of the PEEP setting based on these findings.

scholarly journals Expiratory flow limitation in intensive care: prevalence and risk factors

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Carlo Alberto Volta ◽  
Francesca Dalla Corte ◽  
Riccardo Ragazzi ◽  
Elisabetta Marangoni ◽  
Alberto Fogagnolo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Fluid Balance ◽  
Adverse Outcomes ◽  
Small Airways ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Expected Length ◽  
Expiratory Flow

Abstract Background Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL. Methods Patients admitted to the intensive care unit (ICU) with an expected length of mechanical ventilation of 72 h were enrolled in this prospective, observational study. Patients were evaluated, within 24 h from ICU admission and for at least 72 h, in terms of respiratory mechanics, presence of EFL through the PEEP test, daily fluid balance and followed for outcome measurements. Results Among the 121 patients enrolled, 37 (31%) exhibited EFL upon admission. Flow-limited patients had higher BMI, history of pulmonary or heart disease, worse respiratory dyspnoea score, higher intrinsic positive end-expiratory pressure, flow and additional resistance. Over the course of the initial 72 h of mechanical ventilation, additional 21 patients (17%) developed EFL. New onset EFL was associated with a more positive cumulative fluid balance at day 3 (103.3 ml/kg) compared to that of patients without EFL (65.8 ml/kg). Flow-limited patients had longer duration of mechanical ventilation, longer ICU length of stay and higher in-ICU mortality. Conclusions EFL is common among ICU patients and correlates with adverse outcomes. The major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. Further studies are needed to assess if a restrictive fluid therapy might be associated with a lower incidence of EFL.

Late Breaking Abstract - Non-interventional monitoring of expiratory flow limitation during experimental mechanical ventilation

2020 ◽  
Author(s):  
Giorgos Marinakis ◽  
Michael Paraschos ◽  
Maria Patrani ◽  
Theodoros Tsoutsouras ◽  
Athanasia Kotrotsou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Expiratory Flow

scholarly journals Expiratory Flow Limitation During Mechanical Ventilation

CHEST Journal ◽  
2018 ◽  
Vol 154 (4) ◽  
pp. 948-962 ◽  
Author(s):  
Detajin Junhasavasdikul ◽  
Irene Telias ◽  
Domenico Luca Grieco ◽  
Lu Chen ◽  
Cinta Millan Gutierrez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Expiratory Flow

Expiratory flow limitation and intrinsic positive end-expiratory pressure in obesity

1998 ◽  
Vol 85 (4) ◽  
pp. 1236-1243 ◽  
Author(s):  
W. Pankow ◽  
T. Podszus ◽  
T. Gutheil ◽  
T. Penzel ◽  
J.-H. Peter ◽  
...  
Keyword(s):  
Supine Position ◽  
Lateral Position ◽  
Normal Weight ◽  
Upright Position ◽  
Flow Limitation ◽  
Positive End Expiratory Pressure ◽  
Expiratory Flow Limitation ◽  
Transdiaphragmatic Pressure ◽  
Expiratory Flow ◽  
The Right

Breathing at very low lung volumes might be affected by decreased expiratory airflow and air trapping. Our purpose was to detect expiratory flow limitation (EFL) and, as a consequence, intrinsic positive end-expiratory pressure (PEEPi) in grossly obese subjects (OS). Eight OS with a mean body mass index (BMI) of 44 ± 5 kg/m2 and six age-matched normal-weight control subjects (CS) were studied in different body positions. Negative expiratory pressure (NEP) was used to determine EFL. In contrast to CS, EFL was found in two of eight OS in the upright position and in seven of eight OS in the supine position. Dynamic PEEPi and mean transdiaphragmatic pressure (mean Pdi) were measured in all six CS and in six of eight OS. In OS, PEEPi increased from 0.14 ± 0.06 (SD) kPa in the upright position to 0.41 ± 0.11 kPa in the supine position ( P < 0.05) and decreased to 0.20 ± 0.08 kPa in the right lateral position ( P < 0.05, compared with supine), whereas, in CS, PEEPi was significantly smaller (<0.05 kPa) in each position. In OS, mean Pdi in each position was significantly larger compared with CS. Mean Pdi increased from 1.02 ± 0.32 kPa in the upright position to 1.26 ± 0.17 kPa in the supine position (not significant) and decreased to 1.06 ± 0.26 kPa in the right lateral position ( P < 0.05, compared with supine), whereas there were no significant changes in CS. We conclude that in OS 1) tidal breathing can be affected by EFL and PEEPi; 2) EFL and PEEPi are promoted by the supine posture; and 3) the increased diaphragmatic load in the supine position is, in part, related to PEEPi.

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