The following is a summary of “Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy,” published in the November 2023 issue of Critical Care by Ito et al.
Accurately assessing respiratory effort is essential for maintaining lung and diaphragm health in mechanically ventilated patients. Although esophageal manometry remains the gold standard, its invasiveness and complexity necessitate alternative methods.
Researchers conducted a retrospective study to investigate the correlation between change in esophageal pressure during tidal breathing (∆Pes) and airway pressure measured during three airway occlusion maneuvers, expiratory occlusion pressure (Pocc), airway occlusion pressure (P0.1), and respiratory muscle pressure index (PMI) in children.
They conducted a secondary analysis of physiological data from children (1 month to 18 years) with acute respiratory distress syndrome who participated in an ongoing randomized clinical trial (REDvent, R01HL124666) testing a lung and diaphragm protective ventilation strategy. Measurements included ∆Pes, Pocc, P0.1, and PMI. Repeated measures assessed correlations between ∆Pes and the three measures. Linear regression equations were used to identify potential therapeutic thresholds
The results showed 653 inspiratory and 713 expiratory holds from 97 patients. Pocc exhibited the most robust correlation with ∆Pes (r = 0.68), followed by PMI (r = 0.60) and P0.1 (r = 0.42). ∆Pes could be accurately estimated using the regression equation ∆Pes = 0.66 × Pocc (R2 = 0.82), with Pocc cut-points showing high specificity and moderate sensitivity for detecting respective ∆Pes thresholds denoting high and low respiratory effort. The relationship between Pocc and ∆Pes was consistent across age groups and ventilation modes. However, disparities were more evident with P0.1 and PMI.
They concluded that airway occlusion maneuvers emerged as promising alternatives to esophageal pressure measurement for estimating inspiratory effort in children, with Pocc showing the most potential.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04754-6
