Driving Pressure: Defining the Range.

Abstract:

BACKGROUND:Recent literature suggests that optimization of tidal driving pressure (ΔP) would be a better variable to target for lung protection at the bedside than tidal volume (VT) or plateau pressure (Pplat), the traditional indicators of ventilator-induced lung injury. However, the usual range or variability of ΔP over time for any subject category have not been defined. This study sought to document the ΔP ranges observed in current practice among mechanically ventilated subjects receiving routine care for diverse acute conditions in a community hospital environment. METHODS:This was a retrospective, observational study in a university-affiliated and house staff-aided institution with respiratory care protocols based on extant lung-protective guidelines for VT. Demographic characteristics and measured parameters related to mechanical ventilation and hemodynamics were extracted from electronic records of intubated subjects for each 8-h period of the first 24 h in the ICU. Pplat values reported by the ventilator were validated by the respiratory therapist before those data were entered into the electronic medical record. RESULTS:The mean ΔP was significantly higher at Time 1 (mean 16.1, range 7.0-31.0 cm H2O) compared to both Time 2 (mean 14.5, range 7.0-35.0 cm H2O) (P < .001) and Time 3 (mean 14.8, range 8.0-32 cm H2O) (P < .001). At all time points, the median ΔP was higher for completely passive breathing compared to triggered breathing. The widest difference between presumed entirely passive and presumed intermittently or consistently triggered breaths occurred at Time 1 (mean ΔP = 17.2 vs 14.9 cm H2O, respectively) (P = .01). CONCLUSIONS:Suggested safety thresholds for ΔP are often violated by a strategy that focuses on only VT and Pplat. Our data suggest that ΔP is lower for passive versus triggered breathing cycles. Vigilance is especially important in the initial stages of mechanical ventilator support, and attention should be paid to triggering efforts when interpreting and comparing machine-determined numerical values for ΔP.

journal_name

Respir Care

journal_title

Respiratory care

authors

Baldomero AK,Skarda PK,Marini JJ

doi

10.4187/respcare.06599

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

883-889

issue

8

eissn

0020-1324

issn

1943-3654

pii

respcare.06599

journal_volume

64

pub_type

杂志文章
  • Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO₂ response and acetazolamide treatment effects.

    abstract:OBJECTIVE:In obesity-hypoventilation-syndrome patients mechanically ventilated for hypercapnic respiratory failure we investigated the relationship between CO₂ response, body mass index, and plasma bicarbonate concentration, and the effect of acetazolamide on bicarbonate concentration and CO₂ response. METHODS:CO₂ res...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Raurich JM,Rialp G,Ibáñez J,Llompart-Pou JA,Ayestarán I

    更新日期:2010-11-01 00:00:00

  • Spontaneously breathing lung model comparison of work of breathing between automatic tube compensation and pressure support.

    abstract:INTRODUCTION:Automatic tube compensation (ATC), a new ventilation mode that compensates for the work of breathing imposed by endotracheal tube resistance, recently became commercially available. METHODS:We conducted a laboratory study with a lung model and a Nellcor Puritan Bennett 840 ventilator to compare ATC and pr...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Fujino Y,Uchiyama A,Mashimo T,Nishimura M

    更新日期:2003-01-01 00:00:00

  • Should PEEP Titration Be Based on Chest Mechanics in Patients With ARDS?

    abstract::Functional residual capacity (FRC) is essentially the alveolar volume and a determinant of both oxygenation and respiratory system compliance (CRS). ARDS decreases FRC, and sufficient PEEP restores FRC; thus, assessments of PEEP by its impact on oxygenation and CRS are intimately linked. PEEP also can ameliorate or ag...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.04657

    authors: Kallet RH

    更新日期:2016-06-01 00:00:00

  • Ventilator-Associated Events: What They Are and What They Are Not.

    abstract::In 2013, the United States Centers for Disease Control and Prevention redefined surveillance for quality of care in ventilated patients by shifting from ventilator-associated pneumonia (VAP) definitions to ventilator-associated event (VAE) definitions. VAE definitions were designed to overcome many of the limitations ...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.07059

    authors: Klompas M

    更新日期:2019-08-01 00:00:00

  • Devices Used for CPAP Delivery.

    abstract::CPAP is a spontaneous mode of ventilation that maintains a constant airway pressure during the inspiratory and expiratory phases. This therapeutic modality is used across the continuum of care from pre-hospital treatment to intensive and acute care units to the home care environment to treat a host of acute and chroni...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.06625

    authors: Volsko TA

    更新日期:2019-06-01 00:00:00

  • Spirometric correlates of dyspnea improvement among emergency department patients with chronic obstructive pulmonary disease exacerbation.

    abstract:OBJECTIVE:To examine whether change in slow vital capacity (SVC) correlates to dyspnea improvement during emergency department (ED) treatment of chronic obstructive pulmonary disease (COPD) exacerbation. METHODS:We performed a prospective cohort study and enrolled consecutive patients during a 3-week period. ED patien...

    journal_title:Respiratory care

    pub_type: 杂志文章,多中心研究

    doi:

    authors: Camargo CA Jr,Tsai CL,Clark S,Kenney PA,Radeos MS

    更新日期:2008-07-01 00:00:00

  • Heliox and forward-leaning posture improve the efficacy of nebulized bronchodilator in acute asthma: a randomized trial.

    abstract:BACKGROUND:Heliox and forward-leaning posture (torso inclined forward at 50-60° with the elbows resting on the thighs) are adjuncts in the administration of nebulized bronchodilator to patients with acute asthma. METHODS:We randomized 59 patients who presented to the emergency department in severe asthma crisis, into ...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验

    doi:10.4187/respcare.00963

    authors: Brandão DC,Britto MC,Pessoa MF,de Sá RB,Alcoforado L,Matos LO,Silva TN,de Andrade AD

    更新日期:2011-07-01 00:00:00

  • Pulmonary function and flow-volume loop patterns in patients with tracheobronchomalacia.

    abstract:BACKGROUND:Patterns of pulmonary function tests (PFTs) and flow-volume loops among patients with clinically important tracheobronchomalacia (TBM) are not well described. Small studies suggest 4 main flow-volume loop morphologies: low maximum forced expiratory flow, biphasic expiratory curve, flow oscillations, and notc...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02277

    authors: Majid A,Sosa AF,Ernst A,Feller-Kopman D,Folch E,Singh AK,Gangadharan S

    更新日期:2013-09-01 00:00:00

  • In vitro comparison of the circulaire and AeroTee to a traditional nebulizer T-piece with corrugated tubing.

    abstract:BACKGROUND:Nebulizers are a popular means of delivering aerosolized medication, primarily albuterol, to the bronchial airways of patients, and there has been extensive research done on numerous nebulizers used with nebulizer T-pieces and corrugated tubing. Very little research has been performed on other types of nebul...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Piper SD

    更新日期:2000-03-01 00:00:00

  • Factors that delay COPD detection in the general elderly population.

    abstract:BACKGROUND:In patients with COPD, early detection and rapid treatment are essential to prevent its progression and exacerbations. OBJECTIVE:To identify factors that delay COPD detection. METHODS:We conducted a cross-sectional study of elderly COPD patients and healthy subjects in rural Japan. We measured respiratory ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.01109

    authors: Horie J,Murata S,Hayashi S,Murata J,Miyazaki J,Mizota K,Horikawa E

    更新日期:2011-08-01 00:00:00

  • Inhalable drugs for systemic therapy.

    abstract::Although oral and injectable drug formulations still dominate the market, interest in pulmonary delivery has been rising steadily. Given patients' desire for an alternative to injections, and recent advances in aerosol science and pulmonary medicine, the potential for improved disease management outcomes by using aero...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:

    authors: Corkery K

    更新日期:2000-07-01 00:00:00

  • Successful extracorporeal membrane oxygenation for respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation.

    abstract::We report the first successful use of venovenous extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation. A 23-month-old female with complete immune-incompetent DiGeorge anomaly 65 days after allogenic thymus transplantation was...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.01051

    authors: Hornik CP,Hartman ME,Markert ML,Lodge AJ,Cheifetz IM,Turner DA

    更新日期:2011-06-01 00:00:00

  • Comparison of Flow Resistance Characteristics and Placement of Two Endotracheal Tubes.

    abstract:BACKGROUND:In a traditional endotracheal tube (ETT), there is a linear outward pull through its attachment to the ventilator tubing that leads to risk of accidental dislodgement. This study was conducted to assess the ETT flow characteristics and to evaluate providers' intubation experience using two ETT's in a simulat...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.05813

    authors: Deshpande GG,Sanford JE,Tripathi S

    更新日期:2018-09-01 00:00:00

  • Sleep-disordered breathing may be under-recognized in patients who wean from prolonged mechanical ventilation.

    abstract:BACKGROUND:The prevalence of sleep-disordered breathing (SDB) in patients with prolonged mechanical ventilation (PMV) is unknown. The aim of this study was to assess the frequency of SDB in patients admitted to a long-term acute care (LTAC) hospital who weaned from PMV. METHODS:Retrospective chart review was conducte...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.01260

    authors: Diaz-Abad M,Verceles AC,Brown JE,Scharf SM

    更新日期:2012-02-01 00:00:00

  • Impulse oscillometry for leukotriene D4 inhalation challenge in asthma.

    abstract:BACKGROUND:The value of impulse oscillometry (IOS) for bronchial provocation testing is poorly defined. We investigated the positive threshold derived from the parameters and diagnostic power of IOS for asthma with the leukotriene D(4) bronchial provocation test. METHODS:We enrolled 62 subjects with asthma and 21 heal...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02417

    authors: Guan WJ,Zheng JP,Gao Y,Jiang CY,Shi X,Xie YQ,Liu QX,Jiang M,An JY,Yu XX,Liu WT,Zhong LP,Wu ZP,Zhong NS

    更新日期:2013-12-01 00:00:00

  • Calculation of physiologic dead space: comparison of ventilator volumetric capnography to measurements by metabolic analyzer and volumetric CO2 monitor.

    abstract:BACKGROUND:Calculation of physiologic dead space (dead space divided by tidal volume [VD/VT]) using the Enghoff modification of the Bohr equation requires measurement of the partial pressure of mean expired CO2 (PĒCO2) by exhaled gas collection and analysis, use of a metabolic analyzer, or use of a volumetric CO2 monit...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02116

    authors: Siobal MS,Ong H,Valdes J,Tang J

    更新日期:2013-07-01 00:00:00

  • Spirometry training does not guarantee valid results.

    abstract:BACKGROUND:Many healthcare professionals performing spirometry in primary care have had less than half a day's training in spirometry practice, and the validity of the test results is questionable. Longer training periods, with or without follow-up training, may improve test validity. OBJECTIVE:To determine if a 14-ho...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Borg BM,Hartley MF,Fisher MT,Thompson BR

    更新日期:2010-06-01 00:00:00

  • Longitudinal evaluation of compressor/nebulizer performance.

    abstract:BACKGROUND:Inhaled medications are the mainstay of treatment for maintenance of lung health in patients with cystic fibrosis (CF). Compressor/nebulizer units are used an average of 100-120 min/d by patients with CF. Each compressor/nebulizer has unique flow/pressure characteristics that affect particle size distributio...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02776

    authors: Awad S,Williams DK,Berlinski A

    更新日期:2014-07-01 00:00:00

  • Symptom Clusters and Quality of Life in Subjects With COPD.

    abstract:BACKGROUND:COPD is one of the most common respiratory diseases. Patients with COPD experience and suffer from various physical and psychological symptoms. We performed this study to identify symptom clusters and the effects on quality of life (QOL) in patients with COPD. METHODS:A total of 130 COPD subjects were recru...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.05374

    authors: Lim KE,Kim SR,Kim HK,Kim SR

    更新日期:2017-09-01 00:00:00

  • Deep Breathing Improves End-Tidal Carbon Dioxide Monitoring of an Oxygen Nasal Cannula-Based Capnometry Device in Subjects Extubated After Abdominal Surgery.

    abstract:BACKGROUND:Capnometry detects hypoventilation earlier than pulse oximetry while supplemental oxygen is being administered. We compared the end-tidal CO2 (PETCO2 ) measured using a newly developed oxygen nasal cannula with a CO2-sampling port and the PaCO2 in extubated subjects after abdominal surgery. We also investiga...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.04634

    authors: Takaki S,Mizutani K,Fukuchi M,Yoshida T,Idei M,Matsuda Y,Yamaguchi Y,Miyashita T,Nomura T,Yamaguchi O,Goto T

    更新日期:2017-01-01 00:00:00

  • Values of impulse oscillometry in healthy mexican children and adolescents.

    abstract:BACKGROUND:The impulse oscillometry system (IOS) is increasingly used to evaluate lung function, but individual results must be compared with appropriate reference values. We aimed to obtain such reference values in Mexican children and adolescents. METHODS:Healthy subjects were recruited from kindergartens and school...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.03374

    authors: Gochicoa-Rangel L,Torre-Bouscoulet L,Martínez-Briseño D,Rodríguez-Moreno L,Cantú-González G,Vargas MH

    更新日期:2015-01-01 00:00:00

  • Do directed cough maneuvers improve cough effectiveness in the early period after open heart surgery? Effect of thoracic support and maximal inspiration on cough peak expiratory flow, cough expiratory volume, and thoracic pain.

    abstract:BACKGROUND:Directed cough maneuvers are often included in physiotherapy management aimed at preventing postoperative pulmonary complications after open heart surgery, but there is little scientific evidence of the effectiveness of directed cough maneuvers. METHODS:We conducted a randomized intra-subject crossover tria...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验

    doi:

    authors: Fiore JF Jr,Chiavegato LD,Denehy L,Paisani DM,Faresin SM

    更新日期:2008-08-01 00:00:00

  • Chest radiography validity in screening pulmonary tuberculosis in immigrants from a high-burden country.

    abstract:BACKGROUND:Chest x-ray (CXR) is widely used for diagnosing and screening pulmonary tuberculosis (PTB), yet its validity is debatable and its costs are relatively high. This study aimed to determine the validity of CXR screening in detecting radiological findings compatible with active PTB or with old healed tuberculos...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.01475

    authors: Mor Z,Leventhal A,Weiler-Ravell D,Peled N,Lerman Y

    更新日期:2012-07-01 00:00:00

  • Computerized adventitious respiratory sounds as outcome measures for respiratory therapy: a systematic review.

    abstract:INTRODUCTION:There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be objectively characterized with computerized respiratory sound analysis (CORSA) and have been shown to contribute for diagnosis purposes; ...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.02765

    authors: Marques A,Oliveira A,Jácome C

    更新日期:2014-05-01 00:00:00

  • The conversion to metered-dose inhaler with valved holding chamber to administer inhaled albuterol: a pediatric hospital experience.

    abstract:BACKGROUND:Metered-dose inhalers with valved holding chambers (MDI-VHCs) have been shown to be equivalent to small-volume nebulizers (SVNs) for the delivery of bronchodilators in children. At Seattle Children's Hospital and Regional Medical Center we sought to implement the conversion from SVN to MDI-delivered albutero...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Salyer JW,DiBlasi RM,Crotwell DN,Cowan CA,Carter ER

    更新日期:2008-03-01 00:00:00

  • Diagnostic utility of plasma procalcitonin for nosocomial pneumonia in the intensive care unit setting.

    abstract:BACKGROUND:Nosocomial pneumonia is a difficult diagnosis to establish in the intensive care unit setting, due to the non-specific nature of the clinical and radiographic findings. Procalcitonin is a circulating biomarker that may become elevated in the presence of bacterial infection. METHODS:We conducted a prospectiv...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.00979

    authors: Dallas J,Brown SM,Hock K,Scott MG,Skrupky LP,Boyle WA 3rd,Kollef MH

    更新日期:2011-04-01 00:00:00

  • Evaluation of ten manual resuscitators across an operational temperature range of -18 degrees C to 50 degrees C.

    abstract:UNLABELLED:Because of the temperature extremes encountered during emergency resuscitation and transport in the field, we sought to evaluate the performance and safety of 10 adult resuscitators (5 permanent units: Hope 4, Laerdal, Lifesaver, Mark 3, and PMR; and 5 disposable units: BagEasy, Code Blue, CPR Bag, DMR, and ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Barnes TA,Stockwell DL

    更新日期:1991-03-01 00:00:00

  • Noninvasive ventilation in neuromuscular disease: equipment and application.

    abstract::Noninvasive support of ventilation is commonly needed in patients with neuromuscular disease. Body ventilators, which are used rarely, function by applying intermittent negative pressure to the thorax or abdomen. More commonly, noninvasive positive-pressure ventilation (NPPV) is used. This therapy can be applied with ...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:

    authors: Hess DR

    更新日期:2006-08-01 00:00:00

  • Modification of an external low-pressure ventilator alarm to allow its remote use for isolated patients.

    abstract::The problem of patients in isolation becoming disconnected from their ventilator systems is a serious one, as the closed doors of an isolation room usually prevent hospital personnel outside the room from hearing or seeing standard ventilator alarms To overcome this potentially life-threatening problem, we modified a ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Morganstern MA,Karpel SK

    更新日期:1986-05-01 00:00:00

  • The physiology of dinosaurs: circulatory and respiratory function in the largest animals ever to walk the earth.

    abstract::The cardiopulmonary physiology of dinosaurs-and especially of the long-necked sauropods, which grew much larger than any land animals before or since-should be inherently fascinating to anyone involved in respiratory care. What would the blood pressure be in an animal 12 m (40 ft) tall? How could airway resistance and...

    journal_title:Respiratory care

    pub_type:

    doi:10.4187/002013209793800286

    authors: Pierson DJ

    更新日期:2009-07-01 00:00:00