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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 4/2010

01.04.2010 | Original

Estimation of inspiratory muscle pressure in critically ill patients

verfasst von: Eumorfia Kondili, Christina Alexopoulou, Nectaria Xirouchaki, Katerina Vaporidi, Dimitris Georgopoulos

Erschienen in: Intensive Care Medicine | Ausgabe 4/2010

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Abstract

Background

Recently, a new technology has been introduced aiming to monitor and improve patient ventilator interaction (PVI monitor). With the PVI monitor, a signal representing an estimation of the patient’s total inspiratory muscle pressure (PmusPVI) is calculated from the equation of motion, utilizing estimated values of resistance and elastance of the respiratory system.

Objective

The aim of the study was to prospectively examine the accuracy of PmusPVI to quantify inspiratory muscle pressure.

Methods and interventions

Eleven critically ill patients mechanically ventilated on proportional assist ventilation with load-adjustable gain factors were studied at three levels of assist (30, 50 and 70%). Airway, esophageal, gastric and transdiaphragmatic (Pdi) pressures, volume and flow were measured breath by breath, whereas the total inspiratory muscle pressure (Pmus) was calculated using the Campbell diagram.

Results

For a given assist, PmusPVI throughout inspiration did not differ from the corresponding values calculated using the Pdi and Pmus signals. Inspiratory and expiratory time did not differ among the various methods of calculation. Inspiratory muscle pressure decreased with increasing assist, and the magnitude of this decrease did not differ among the various methods of pressure calculation.

Conclusions

A signal generated from flow, volume and airway pressure may be used to provide breath-by-breath quantitative information of inspiratory muscle pressure.
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Literatur
1.
Slutsky AS (1994) Consensus conference on mechanical ventilation—January 28–30, 1993 at Northbrook, Illinois, USA. Part I. European Society of Intensive Care Medicine, the ACCP and the SCCM. Intensive Care Med 20:64–79CrossRefPubMed
2.
3.
Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358:1327–1335CrossRefPubMed
4.
Shanely RA, Zergeroglu MA, Lennon SL, Sugiura T, Yimlamai T, Enns D, Belcastro A, Powers SK (2002) Mechanical ventilation-induced diaphragmatic atrophy is associated with oxidative injury and increased proteolytic activity. Am J Respir Crit Care Med 166:1369–1374CrossRefPubMed
5.
Sassoon CS, Zhu E, Caiozzo VJ (2004) Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med 170:626–632CrossRefPubMed
6.
Futier E, Constantin JM, Combaret L, Mosoni L, Roszyk L, Sapin V, Attaix D, Jung B, Jaber S, Bazin JE (2008) Pressure support ventilation attenuates ventilator-induced protein modifications in the diaphragm. Crit Care 12:R116CrossRefPubMed
7.
Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Mutz N (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164:43–49PubMed
8.
Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMed
9.
Hooper MH, Girard TD (2009) Sedation and weaning from mechanical ventilation: linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes. Crit Care Clin 25:515–525 viiiCrossRefPubMed
10.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327CrossRefPubMed
11.
MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120:375S–395SCrossRefPubMed
12.
Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112:1592–1599CrossRefPubMed
13.
Willatts SM, Drummond G (2000) Brainstem death and ventilator trigger settings. Anesthesia 55:676–677CrossRef
14.
Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient–ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522CrossRefPubMed
15.
Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436CrossRefPubMed
16.
Laghi F (2005) Assessment of respiratory output in mechanically ventilated patients. Respir Care Clin N Am 11:173–199CrossRefPubMed
17.
Georgopoulos D, Mitrouska I, Webster K, Bshouty Z, Younes M (1997) Effects of inspiratory muscle unloading on the response of respiratory motor output to CO2. Am J Respir Crit Care Med 155:2000–2009PubMed
18.
Yamada Y, Shigeta M, Suwa K, Hanaoka K (1994) Respiratory muscle pressure analysis in pressure-support ventilation. J Appl Physiol 77:2237–2243PubMed
19.
Parthasarathy S, Jubran A, Tobin MJ (2000) Assessment of neural inspiratory time in ventilator-supported patients. Am J Respir Crit Care Med 162:546–552PubMed
20.
Beck J, Sinderby C, Lindstrom L, Grassino A (1998) Effects of lung volume on diaphragm EMG signal strength during voluntary contractions. J Appl Physiol 85:1123–1134PubMed
21.
Sinderby C, Beck J, Spahija J, de Marchie M, Lacroix J, Navalesi P, Slutsky AS (2007) Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest 131:711–717CrossRefPubMed
22.
Sinderby C, Spahija J, Beck J, Kaminski D, Yan S, Comtois N, Sliwinski P (2001) Diaphragm activation during exercise in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163:1637–1641PubMed
23.
Younes M, Webster K, Kun J, Roberts D, Masiowski B (2001) A method for measuring passive elastance during proportional assist ventilation. Am J Respir Crit Care Med 164:50–60PubMed
24.
Younes M, Kun J, Masiowski B, Webster K, Roberts D (2001) A method for noninvasive determination of inspiratory resistance during proportional assist ventilation. Am J Respir Crit Care Med 163:829–839PubMed
25.
Younes M, Brochard L, Grasso S, Kun J, Mancebo J, Ranieri M, Richard JC, Younes H (2007) A method for monitoring and improving patient: ventilator interaction. Intensive Care Med 33:1337–1346CrossRefPubMed
26.
Kondili E, Alexopoulou C, Prinianakis G, Xirouchaki N, Georgopoulos D (2004) Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease. Intensive Care Med 30:1311–1318PubMed
27.
Kondili E, Prinianakis G, Alexopoulou C, Vakouti E, Klimathianaki M, Georgopoulos D (2006) Respiratory load compensation during mechanical ventilation–proportional assist ventilation with load-adjustable gain factors versus pressure support. Intensive Care Med 32:692–699CrossRefPubMed
28.
D’Angelo E, Robatto FM, Calderini E, Tavola M, Bono D, Torri G, Milic-Emili J (1991) Pulmonary and chest wall mechanics in anesthetized paralyzed humans. J Appl Physiol 70:2602–2610PubMed
29.
Brochard L (2002) Intrinsic (or auto-) positive end-expiratory pressure during spontaneous or assisted ventilation. Intensive Care Med 28:1552–1554CrossRefPubMed
30.
Rodarte JR, Rehder K (1986) Dynamics of respiration. In: Macklem PT, Mead J (eds) Handbook of physiology. The respiratory system, section 3. Mechanics of breathing, vol 3. The American Physiological Society, Bethesda, pp 131–144
31.
Tobin MJ, Laghi F, Brochard LJ (2009) Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol 107:962–970CrossRefPubMed
32.
Parthasarathy S, Jubran A, Laghi F, Tobin MJ (2007) Sternomastoid, rib cage, and expiratory muscle activity during weaning failure. J Appl Physiol 103:140–147CrossRefPubMed
33.
Conti G, Dell’Utri D, Vilardi V, De Blasi RA, Pelaia P, Antonelli M, Bufi M, Rosa G, Gasparetto A (1993) Propofol induces bronchodilation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients. Acta Anaesthesiol Scand 37:105–109CrossRefPubMed
34.
Kondili E, Prinianakis G, Athanasakis H, Georgopoulos D (2002) Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure. Eur Respir J 19:811–819CrossRefPubMed
35.
Thille AW, Cabello B, Galia F, Lyazidi A, Brochard L (2008) Reduction of patient–ventilator asynchrony by reducing tidal volume during pressure support ventilation. Intensive Care Med 34:1477–1486CrossRefPubMed
36.
de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK (2009) Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med 37:2740–2745CrossRefPubMed
37.
Jubran A, Tobin MJ (1997) Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915PubMed
38.
Brochard L, Pluskwa F, Lemaire F (1987) Improved efficacy of spontaneous breathing with inspiratory pressure support. Am Rev Respir Dis 136:411–415PubMed
Metadaten
Titel
Estimation of inspiratory muscle pressure in critically ill patients
verfasst von
Eumorfia Kondili
Christina Alexopoulou
Nectaria Xirouchaki
Katerina Vaporidi
Dimitris Georgopoulos
Publikationsdatum
01.04.2010
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 4/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-1753-4

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