Prognostic value of mechanical power and transpulmonary pressure guided recruitment maneuver in patients with acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Xiaodong ¹ , LI Tian ² , DI Xingwei ¹ , HU Zhansheng ¹ , HAO Chunyan ¹ ,  FU Haiyan ¹ , JIANG Huamao ¹

1. Department of Critical Care Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R. China;
2. Department of Respiratory, the Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R. China;

Corresponding author：

FU Haiyan, Email: 1303627356@qq.com

Keywords：

Mechanical power; transpulmonary pressure; acute respiratory distress syndrome; lung recruitment maneuver

DOI：

10.7507/1671-6205.202307006

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the titration of best positive end-expiratory pressure (Best PEEP) based on mechanical power (MP) and transpulmonary pressure monitoring during lung reexpansion in patients with acute respiratory distress syndrome (ARDS), and to analyze the value of both in evaluating the prognosis of ARDS patients.Methods ARDS patients treated in the intensive care Unit of the First Affiliated Hospital of Jinzhou Medical University from September 2021 to March 2023 were selected and divided into survival group and death group according to the 28-day mortality rate. After full sedation, esophageal pressure tube was inserted through the nasal passage, and lung recruitment maneuvers (RM) was performed by incremental PEEP method. The Best PEEP method was titrated based on MP and transpulmonary pressure. Pearson correlation analysis was used to analyze the correlation between MP at RM 30 min and 2 h and transpulmonary pressure. The changes of clinical indicators at 30 minutes and 2 hours after RM were compared between the two groups with different outcomes. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 2 h MP and transpulmonary pressure for 28-day mortality in ARDS patients. Results MP and transpulmonary pressure in the survival group decreased significantly at 30 min and 2 h, while MP and transpulmonary pressure in the death group showed a significant upward trend (P < 0.05). The Best PEEP and RR at 30 min and 2 h of the RM in the survival group were lower than those in the death group (P < 0.05). Pearson correlation analysis showed that MP at RM 30 min and 2 h was significantly correlated with transpulmonary pressure (r = 0.710 and 0.804, P < 0.05). The area under the ROC curve of MP and transpulmonary pressure were 0.812 and 0.795, respectively. 95% confidencial interval: 0.704 - 0.920 and 0.687 - 0.903 (P < 0.05); The sensitivity was 86.95% and 82.50%, respectively. The specificity were 76.67% and 59.40%; The positive predictive values were 0.851 and 0.688; The negative predictive values were 0.793 and 0.759; The optimal cut-off values were 15.5 and 17.5, respectively. RM 2 h MP and transpulmonary pressure have good predictive value for 28-day mortality in ARDS patients. Conclusion Monitoring MP and transpulmonary pressure during lung recruitment maneuver can effectively guide the titration of Best PEEP in ARDS patients, and both have good evaluation value for the prognosis of ARDS patients.

Citation： LI Xiaodong, LI Tian, DI Xingwei, HU Zhansheng, HAO Chunyan, FU Haiyan, JIANG Huamao. Prognostic value of mechanical power and transpulmonary pressure guided recruitment maneuver in patients with acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(10): 697-701. doi: 10.7507/1671-6205.202307006 Copy

1.	Pelosi P, Ball L, Barbas CSV, et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care, 2021, 25(1): 250.
2.	Tonna JE, Peltan I, Brown SM, et al. Mechanical power and driving pressure as predictors of mortality among patients with ARDS. Intensive Care Med, 2020, 46(10): 1941-1943.
3.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
4.	孙秀梅, 陈光强, 杨燕琳, 等. 辅助通气时应用食道测压管的气囊压力-容积曲线校正食道压的可行性研究. 中华危重病急救医学, 2020, 32(7): 808-813.
5.	邸兴伟, 李晓东, 胡占升. ARDS患者功能残气量与跨肺压的相关性以及二者对预后的预测价值研究. 中华危重病急救医学, 2020, 32(2): 166-170.
6.	Banavasi H, Nguyen P, Osman H, et al. Management of ARDS - What Works and What Does Not. Am J Med Sci, 2021, 362(1): 13-23.
7.	Sarge T, Baedorf-Kassis E, Banner-Goodspeed V, et al. Effect of esophageal pressure-guided positive end-expiratory pressure on survival from acute respiratory distress syndrome: a risk-based and mechanistic reanalysis of the EPVent-2 Trial. Am J Respir Crit Care Med, 2021, 204(10): 1153-1163.
8.	Coppola S, Caccioppola A, Froio S, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care, 2020, 24(1): 246-255.
9.	夏金根, 詹庆元. 应用食道压力指导急性呼吸窘迫综合征患者呼气末正压的设置. 中国呼吸与危重监护杂志, 2019, 18(2): 189-192.
10.	唐敏, 李娜. 急性呼吸窘迫综合征发病机制及相关生物标志物的研究进展. 中国现代医学杂志, 2022, 32(5): 1-6.
11.	谢永鹏, 钱颖, 刘克喜, 等. ARDS患者机械功与肺部超声评分的相关性以及二者对预后的评估价值. 中华危重病急救医学, 2019, 31(6): 704-708.
12.	怀佳萍, 蒋晨琳, 邓鸿胜, 等. 肺泡灌洗液炎性因子对急性呼吸窘迫综合征患者肺复张潜能的评估价值. 中国全科医学, 2023, 26(3): 329-334.
13.	Su PL, Zhao Z, Ko YF, et al. Spontaneous breathing and pendelluft in patients with acute lung injury: a narrative review. J Clin Med, 2022, 11(24): 7449.
14.	Madahar P, Talmor D, Beitler JR. Transpulmonary pressure-guided ventilation to attenuate atelectrauma and hyperinflation in acute lung injury. Am J Respir Crit Care Med, 2021, 203(8): 934-937.

1. Pelosi P, Ball L, Barbas CSV, et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care, 2021, 25(1): 250.
2. Tonna JE, Peltan I, Brown SM, et al. Mechanical power and driving pressure as predictors of mortality among patients with ARDS. Intensive Care Med, 2020, 46(10): 1941-1943.
3. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
4. 孙秀梅, 陈光强, 杨燕琳, 等. 辅助通气时应用食道测压管的气囊压力-容积曲线校正食道压的可行性研究. 中华危重病急救医学, 2020, 32(7): 808-813.
5. 邸兴伟, 李晓东, 胡占升. ARDS患者功能残气量与跨肺压的相关性以及二者对预后的预测价值研究. 中华危重病急救医学, 2020, 32(2): 166-170.
6. Banavasi H, Nguyen P, Osman H, et al. Management of ARDS - What Works and What Does Not. Am J Med Sci, 2021, 362(1): 13-23.
7. Sarge T, Baedorf-Kassis E, Banner-Goodspeed V, et al. Effect of esophageal pressure-guided positive end-expiratory pressure on survival from acute respiratory distress syndrome: a risk-based and mechanistic reanalysis of the EPVent-2 Trial. Am J Respir Crit Care Med, 2021, 204(10): 1153-1163.
8. Coppola S, Caccioppola A, Froio S, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care, 2020, 24(1): 246-255.
9. 夏金根, 詹庆元. 应用食道压力指导急性呼吸窘迫综合征患者呼气末正压的设置. 中国呼吸与危重监护杂志, 2019, 18(2): 189-192.
10. 唐敏, 李娜. 急性呼吸窘迫综合征发病机制及相关生物标志物的研究进展. 中国现代医学杂志, 2022, 32(5): 1-6.
11. 谢永鹏, 钱颖, 刘克喜, 等. ARDS患者机械功与肺部超声评分的相关性以及二者对预后的评估价值. 中华危重病急救医学, 2019, 31(6): 704-708.
12. 怀佳萍, 蒋晨琳, 邓鸿胜, 等. 肺泡灌洗液炎性因子对急性呼吸窘迫综合征患者肺复张潜能的评估价值. 中国全科医学, 2023, 26(3): 329-334.
13. Su PL, Zhao Z, Ko YF, et al. Spontaneous breathing and pendelluft in patients with acute lung injury: a narrative review. J Clin Med, 2022, 11(24): 7449.
14. Madahar P, Talmor D, Beitler JR. Transpulmonary pressure-guided ventilation to attenuate atelectrauma and hyperinflation in acute lung injury. Am J Respir Crit Care Med, 2021, 203(8): 934-937.

Chinese Journal of Respiratory and Critical Care Medicine

Prognostic value of mechanical power and transpulmonary pressure guided recruitment maneuver in patients with acute respiratory distress syndrome

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content