scholarly journals Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec

2020 ◽  
Vol 1 (1) ◽  
pp. 8-13
Author(s):  
Natsumi Hamahata ◽  
Ryota Sato ◽  
Kimiyo Yamasaki ◽  
Sophie Pereira ◽  
Ehab Daoud
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Normal Lung ◽  
P Value ◽  
Occlusion Pressure ◽  
Mechanical Ventilators ◽  
Airway Occlusion ◽  
Esophageal Balloon ◽  
Airway Occlusion Pressure

Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure

Work of Breathing and Airway Occlusion Pressure during Assist-Mode Mechanical Ventilation

CHEST Journal ◽  
1988 ◽  
Vol 93 (3) ◽  
pp. 571-576 ◽  
Author(s):  
Catherine S.H. Sassoon ◽  
C. Kees Mahutte ◽  
Teresita T. Te ◽  
Daniel H. Simmons ◽  
Richard W. Light
Keyword(s):  
Mechanical Ventilation ◽  
Work Of Breathing ◽  
Occlusion Pressure ◽  
Airway Occlusion ◽  
Airway Occlusion Pressure

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals APHACHE Score as a Predictive Indices for Weanability from Mechanical Ventilation

2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Private Hospital ◽  
Total Duration ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Apache Score ◽  
Number Of Patients ◽  
Weaning Outcome

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22

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