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Transpulmonary driving pressure during mechanical ventilation-validation of a non-invasive measurement method

Journal article
Authors Magni Gudmundsson
Per Persson
G. Perchiazzi
Stefan Lundin
Christian Rylander
Published in Acta Anaesthesiologica Scandinavica
ISSN 0001-5172
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Language en
Links dx.doi.org/10.1111/aas.13482
Keywords lung injury, mechanical ventilation, PEEP, transpulmonary pressure, ventilator-induced lung injury, esophageal pressure, pleural pressure, lung elastance, balloon, Anesthesiology
Subject categories Anaesthetics

Abstract

Background Transpulmonary driving pressure plays an important role in today's understanding of ventilator induced lung injury. We have previously validated a novel non‐invasive method based on stepwise increments of PEEP to assess transpulmonary driving pressure in anaesthetised patients with healthy lungs. The aim of this study was to validate the method in patients who were mechanically ventilated for different diagnoses requiring intensive care. Methods We measured transpulmonary pressure (Ptp) and calculated transpulmonary driving pressure (ΔPtp) in 31 patients undergoing mechanical ventilation in an intensive care unit. Parallel triplicate measurements were performed with the PEEP step method (PtpPSM) and the conventional oesophageal balloon method (Ptpconv). Their agreement was compared using the intraclass correlation coefficient (ICC) and the Bland Altman plot. Result The coefficient of variation for the repeated measurements was 4,3 for ΔPtpPSM and 9,2 for ΔPtpconv. The ICC of 0,864 and the Bland Altman plot indicate good agreement between the two methods. Conclusion The non‐invasive method can be applied in mechanically ventilated patients to measure transpulmonary driving pressure with good repeatability and accuracy comparable to the traditional oesophageal balloon method.

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