Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Protocol
2.2. Measurements
2.3. Statistical Analysis
3. Results
3.1. Breathing Pattern and Respiratory Mechanics
3.2. Gas Exchange and Hemodynamics
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Study Population (n = 28) |
---|---|
Age, years | 72 (56–78) |
Male sex, % (n) | 71 (20) |
Height, cm | 168 (164–172) |
Weight, kg | 71 (66–89) |
BMI, kg/m2 | 25 (22–31) |
SAPS II | 45 (35–51) |
Origin of ARDS, % (n) | |
Pulmonary Extrapulmonary | 71 (20) 29 (8) |
ARDS severity | |
Mild, % (n) Moderate, % (n) Severe, % (n) | 36 (10) 64 (18) 0 (0) |
Duration of mechanical ventilation, days | 15 (11–22) |
Intensive care unit length of stay, days | 16 (14–24) |
Intensive care unit mortality, % (n) | |
Dead Alive | 43 (12) 57 (16) |
Tidal volume, mL | 458 (432–471) |
Tidal volume per predicted body weight, mL/kg | 8.7 (8.2–8.9) |
Respiratory rate, bpm | 16 (15–17) |
Minute ventilation, L/min | 7.2 (6.5–7.4) |
PEEP, cmH2O | 11.3 (10.4–11.5) |
Driving pressure, cmH2O | 10.6 (9.2–11.0) |
Respiratory system Elastance, cmH2O/L | 20.4 (16.0–21.6) |
PaCO2, mmHg | 51.5 (46.4–53.2) |
PaO2, mmHg | 72.8 (68.0–84.5) |
FiO2, mmHg | 0.4 (0.4–0.5) |
PaO2/FiO2 | 182 (151–189) |
Breathing Pattern | DE | TDE | SQ | SIN | p |
Respiratory rate, bpm | 16 (15–17) | 16 (15–17) | 16 (15–17) | 16 (15–17) | 0.397 |
Tidal volume, mL | 465 (428–500) | 465 (428–500) | 465 (428–500) | 465 (428–500) | 0.735 |
Minute ventilation, L/min | 7.3 (6.7–8.3) | 7.3 (6.7–8.3) | 7.3 (6.7–8.3) | 7.3 (6.7–8.3) | 0.155 |
Total breathing time, s | 3.7 (3.5–4.0) | 3.7 (3.5–4.0) | 3.7 (3.5–4.0) | 3.7 (3.5–4.0) | 0.397 |
Inspiratory time, s | 1.1 (1.0–1.1) | 1.1 (1.0–1.1) | 1.1 (1.0–1.1) | 1.1 (1.0–1.1) | 0.389 |
Inspiratory Peak flow, mL/s | 696 (622–761) | 480 (428–539) * | 411 (364–459) *,# | 611 (533–494) *,°,# | <0.001 |
Mean Inspiratory flow, L/min | 23.7 (20.8–26.1) | 23.0 (19.4–24.7) * | 21.8 (19.7–24.8) * | 23.9 (21.3–26.4) °,# | 0.020 |
Respiratory Mechanics Variables | DE | TDE | SQ | SIN | p |
---|---|---|---|---|---|
Airway Peak pressure, cmH2O | 28.5 (25.0–33.2) | 27.8 (23.8–31) | 28.5 (25–32.2) ° | 28.4 (25.8–33.8) ° | <0.001 |
Airway Plateau pressure, cmH2O | 20.3 (18.4–22.9) | 20.2 (17.9–22.3) | 20.0 (18.2–22.2) * | 20.8 (18.2–22.2) | 0.008 |
Driving pressure, cmH2O | 8.9 (7.7–11.0) | 8.9 (7.8–10.9) | 8.7 (7.5–10.3) | 8.7 (7.9–10.8) | 0.082 |
Mean airway pressure, cmH2O | 17 (15–18) | 16 (14–17) | 15 (14–17) | 16 (14–16) | 0.276 |
Respiratory system elastance, cmH2O/L | 19.5 (15.8–26.1) | 19.1 (15.3–25.4) | 18.1 (15.5–23.3) | 19.9 (15.8–25.0) | 0.195 |
Lung elastance, cmH2O/L | 13.1 (9.6–17.2) | 12.6 (9.8–15.8) | 11.9 (9.1–15.5) | 12.4 (10.0–16.9) | 0.132 |
Chest wall elastance, cmH2O/L | 7.2 (5.4–8.6) | 6.5 (4.7–8.4) | 6.7 (6.0–8.3) | 6.9 (5.0–8.7) | 0.412 |
Mechanical power, J/min | 17.5 (12.8–19.7) | 17.0 (13.4–18.3) | 16.7 (14.2–19.7) ° | 18.2 (14.0–20.8) ° | 0.002 |
End-expiratory lung volume, mL | 1269 (787–1621) | 1172 (829–1658) | 1172 (729–1608) | 1249 (829–1671) | 0.998 |
Gas Exchange Variables | DE | TDE | SQ | SIN | p |
---|---|---|---|---|---|
PaO2, mmHg | 73 (68–88) | 71 (67–80) | 70 (68–79) * | 73 (68–83) | 0.039 |
PaO2/FiO2, mmHg | 181 (156–242) | 176 (156–218) | 176 (152–218) * | 172 (152–211) | 0.030 |
Right-to-left shunt, % | 32 ± 8 | 36 ± 12 | 36 ± 10 | 36 ± 9 * | 0.004 |
PaCO2, mmHg | 47 (42–56) | 47 (43–58) | 50 (43–58) * | 47 (43–61) * | 0.003 |
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Chiumello, D.; Meli, A.; Pozzi, T.; Lucenteforte, M.; Simili, P.; Sterchele, E.; Coppola, S. Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients. J. Clin. Med. 2021, 10, 4756. https://doi.org/10.3390/jcm10204756
Chiumello D, Meli A, Pozzi T, Lucenteforte M, Simili P, Sterchele E, Coppola S. Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients. Journal of Clinical Medicine. 2021; 10(20):4756. https://doi.org/10.3390/jcm10204756
Chicago/Turabian StyleChiumello, Davide, Andrea Meli, Tommaso Pozzi, Manuela Lucenteforte, Paolo Simili, Elda Sterchele, and Silvia Coppola. 2021. "Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients" Journal of Clinical Medicine 10, no. 20: 4756. https://doi.org/10.3390/jcm10204756