Document Detail

A simple bedside approach to measurement of respiratory mechanics in critically ill patients.
MedLine Citation:
PMID:  16599866     Owner:  NLM     Status:  PubMed-not-MEDLINE    
OBJECTIVE: To describe and evaluate clinically applicable approaches to measurement of respiratory mechanics in critically ill patients. DATA SOURCES: Methodological and evaluation studies of respiratory mechanics in critically ill patients from relevant MEDLINE searches. SUMMARY OF REVIEW: In ventilated subjects clinically important respiratory system mechanics can be measured using airway pressure and flow data. However, since the respiratory system consists of the lung and chest wall, and chest wall mechanics can markedly alter respiratory system mechanics, it is preferable to compartmentalise these parameters with concurrent measurement of oesophageal, and preferably gastric pressure. Additional care must be taken with interpretation of these data since elastance and resistance may be influenced by frequency, volume, volume history and flow. Tissue viscoelasticity and non-homogeneity of regional time constants are responsible for stress adaptation, which can be measured simply, and accounts for some of these effects on elastance and resistance, and for a systematic difference between static and dynamic intrinsic PEEP. Elastance can be measured using the end-inspiratory occlusion technique, or from either static or dynamic volume-pressure curves. PEEP-mediated recruitment can be measured following referencing of these curves to FRC. Similarly, resistance can be measured from either end-inspiratory occlusion or dynamic pressure and flow data. CONCLUSIONS: Some of this information is available on modern ventilators, but greater insight requires measurement and manipulation of flow and pressure data using a pneumotachograph and pressure transducers. Given the importance of respiratory mechanics in the management of many critically ill patients, and given how poorly the respiratory system is monitored compared with the cardiovascular system, it is worth considering making this simple but additional effort.
A D Bersten
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine     Volume:  1     ISSN:  1441-2772     ISO Abbreviation:  Crit Care Resusc     Publication Date:  1999 Mar 
Date Detail:
Created Date:  2006-04-07     Completed Date:  2006-04-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100888170     Medline TA:  Crit Care Resusc     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  74-84     Citation Subset:  -    
Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, South Australia.
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