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Comparison of 2 correction methods for absolute values of esophageal pressure in subjects with acute hypoxemic respiratory failure, mechanically ventilated in the ICU.
MedLine Citation:
PMID:  23233496     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: A recent trial showed that setting PEEP according to end-expiratory transpulmonary pressure (P(pl,ee)) in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) might improve patient outcome. P(pl,ee) was obtained by subtracting the absolute value of esophageal pressure (P(es)) from airway pressure an invariant value of 5 cm H(2)O. The goal of the present study was to compare 2 methods for correcting absolute P(es) values in terms of resulting P(pl,ee) and recommended PEEP.
METHODS: Measurements collected prospectively from 42 subjects with various forms of acute hypoxemic respiratory failure receiving mechanical ventilation in ICU were analyzed. P(es) was measured at PEEP (P(es,ee)) and at relaxation volume of the respiratory system Vr (P(es,Vr)), obtained by allowing the subject to exhale into the atmosphere (zero PEEP). Two methods for correcting P(es) were compared: Talmor method (P(pl,ee,Talmor) = P(es,ee) - 5 cm H(2)O), and Vr method (P(es,ee,Vr) = P(es,ee) - P(es,Vr)). The rationale was that P(es,Vr) was a more physiologically based correction factor than an invariant value of 5 cm H(2)O applied to all subjects.
RESULTS: Over the 42 subjects, median and interquartile range of P(es,ee) and P(es,Vr) were 11 (7-14) cm H(2)O and 8 (4-11) cm H(2)O, respectively. P(pl,ee,Talmor) was 6 (1-8) cm H(2)O, and P(es,ee,Vr) was 2 (1-5) cm H(2)O (P = .008). Two groups of subjects were defined, based on the difference between the 2 corrected values. In 28 subjects P(pl,ee,Talmor) was ≥ P(es,ee,Vr) (7 [5-9] cm H(2)O vs 2 [1-5] cm H(2)O, respectively), while in 14 subjects P(es,ee,Vr) was > P(pl,ee,Talmor) (2 [0-4] cm H(2)O vs -1 [-3 to 2] cm H(2)O, respectively). P(pl,ee,Vr) was significantly greater than P(pl,ee,Talmor) (7 [5-11] cm H(2)O vs 5 [2-7] cm H(2)O) in the former, and significantly lower in the latter (1 [-2 to 6] cm H(2)O vs 6 [4-9] cm H(2)O).
CONCLUSIONS: Referring absolute P(es) values to Vr rather than to an invariant value would be better adapted to a patient's physiological background. Further studies are required to determine whether this correction method might improve patient outcome.
Authors:
Claude Guérin; Jean-Christophe Richard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respiratory care     Volume:  57     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2045-51     Citation Subset:  IM    
Affiliation:
Service de Réanimation Médicale, Hôpital de la Croix Rousse, and with Hospices Civils de Lyon, University of Lyon, Lyon, France.
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