2017, Number 6
<< Back Next >>
Med Crit 2017; 31 (6)
Association and predictive value of mechanical power with ventilator-free days
Rosas SK, Gutiérrez ZD, Cerón DUW
Language: Spanish
References: 20
Page: 320-325
PDF size: 192.50 Kb.
ABSTRACT
Introduction: Pulmonary disease attributable to mechanical ventilation (MV) has been named ventilator-associated lung injury (VALI). The mechanical power formula (MP) brings together the main variables that determine VALI development. It analyzes the correlation between MP and ventilator-free days (VFD), as well as the predictive capacity for VFD.
Material and methods: We studied 40 patients admitted to the intensive care unit (ICU) and who met the inclusion criteria. Demographic, clinical and laboratory data were collected. MP calculation was performed in the first 24 hours of ICU stay and we determined VFD, ICU stay and ICU mortality. The Spearman’s rho test was performed to determine the correlation between MP and VFD; we performed the bi-varied and later multivariate binary regression analysis. To evaluate the predictive capacity of the variables that were independently related, we compared the areas under the curve (AUC) in the receiver operating characteristics (COR) curve.
Results: MP and VFD have an inverse correlation with intermediate magnitude. They were independently associated: MP OR 2.07, 95% CI (1.10-4.09), p = 0.01, respiratory rate OR 1.5, 95% CI (1.05-2.3), p = 0.04 and Tv/ kg (≤ 8.2 mL) OR 0.01, 95% CI (0.001-0.10), p = 0.002. MP (AUC) 0.75, 95% CI (0.59-0.90), p = 0.007, respiratory rate (ABC) 0.71, 95% CI (0.54-0.88), p = 0.01 and Tv/kg (ABC) 0.92, IC (0.83-1.0), p = 0.001.
Conclusion: MP and VFD have inverse correlation, with ability for predicting VFD, with a cutoff point of 13 Joules/min.
REFERENCES
De Prost N, Ricard JD, Saumon G, Dreyfuss D. Ventilator-induced lung injury: historical perspectives and clinical implications. Ann Intensive Care. 2011;1(1):28.
Rocco PR, Dos Santos C, Pelosi P. Pathophysiology of ventilator-associated lung injury. Curr Opin Anaesthesiol. 2012;25(2):123-130.
Avignon PD, Hedenstrom G, Hedman C. Pulmonary complications in respirator patients. Acta Med Scand Suppl. 1956;316:86-90.
Slutsky AS. Lung injury caused by mechanical ventilation. Chest. 1999;116(1 Suppl):9S-15S.
Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-2136.
Sartori C, Matthay MA. Alveolar epithelial fluid transport in acute lung injury: new insights. Eur Respir J. 2002;20(5):1299-1313.
Saddy F, Sutherasan Y, Rocco PR, Pelosi P. Ventilator-associated lung injury during assisted mechanical ventilation. Semin Respir Crit Care Med. 2014;35(4):409-417.
Beitler JR, Malhotra A, Thompson BT. Ventilator-induced lung injury. Clin Chest Med. 2016;37(4):633-646.
Brochard L. Ventilation-induced lung injury exists in spontaneously breathing patients with acute respiratory failure: yes. Intensive Care Med. 2017;43(2):250-252.
Suki B, Hubmayr R. Epithelial and endothelial damage induced by mechanical ventilation modes. Curr Opin Crit Care. 2014;20(1):17-24.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178(4):346-355.
Nieman GF, Satalin J, Andrews P, Aiash H, Habashi NM, Gatto LA. Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI). Intensive Care Med Exp. 2017;5(1):8.
Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755.
Protti A, Maraffi T, Milesi M, Votta E, Santini A, Pugni P, et al. Role of strain rate in the pathogenesis of ventilator-induced lung edema. Crit Care Med. 2016;44(9):e838-e845.
Biehl M, Kashiouris MG, Gajic O. Ventilator-induced lung injury: minimizing its impact in patients with or at risk for ARDS. Respir Care. 2013;58(6):927-937.
Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology. 2016;124(5):1100-1108.
Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
Yoshida T, Fujino Y, Amato MB, Kavanagh BP. Fifty years of research in ARDS. Spontaneous breathing during mechanical ventilation. risks, mechanisms, and management. Am J Respir Crit Care Med. 2017;195(8):985-992.
Chiumello D, Carlesso E, Brioni M, Cressoni M. Airway driving pressure and lung stress in ARDS patients. Crit Care. 2016;20:276.
Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM, et al. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016;20(1):384.