Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

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Barberis, L. et al.

Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients.

OBJECTIVE: To compare the values of plateau pressure (Pplat) recorded at different times after end-inspiratory occlusion and those of static elastance (Est,rs) and total resistance (Rrs) of the respiratory system. DESIGN: Physiological study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Eleven patients with ARDS and ten patients with COPD requiring tracheal intubation and mechanical ventilation were investigated. COPD patients were investigated on zero end-expiratory pressure (ZEEP) and ARDS patients on both ZEEP and positive end-expiratory pressure (PEEP). MEASUREMENTS AND RESULTS: Respiratory mechanics were assessed using the rapid airway occlusion technique. Tracheal pressure (Ptr) was measured downstream the endotracheal tube. Ptr was recorded 0.5 s, 1 s, 2 s, 3 s, and 5 s after a 5-s end-inspiratory occlusion. Est,rs and Rrs were computed at the same times using standard formula. In ARDS patients on ZEEP, Pplat amounted to 20+/-5, 20+/-5, 19+/-5, 19+/-5, and 18+/-5 cmH(2)O at 0.5, 1, 2, 3 and 5 s, respectively (P <0.001). In COPD patients, these values were 18+/-4 cmH(2)O, 17+/-4 cmH(2)O, 17+/-4 cmH(2)O, 16+/-4 cmH(2)O, and 16+/-4 cmH(2)O (P <0.001). Except for one ARDS patient on PEEP, Pplat was always less than 35 cmH(2)O, regardless of the time of measurement. As compared to 5 s, measurements at 0.5 s resulted in overestimation of Est,rs by 14% and 29% and in underestimation of Rrs by 34% and 24%, in ARDS and COPD patients, respectively. CONCLUSIONS: Very early post-occlusion values of Pplat were statistically greater than at 3 s or 5 s. This probably has no major impact on the occurrence of volutrauma. Clinicians must be aware, however, that Est,rs and Rrs are greatly modified by the time of recording of Pplat.[1]

References

Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Barberis, L., Manno, E., Guérin, C. Intensive care medicine. (2003) [Pubmed]

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