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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

Respiratory Mechanics in Acute Respiratory Distress Syndrome: A Quality Improvement Based Registry Project

  • 1, 2,
  • 1, 2, 3,
  • 4,
  • 4,
  • 4,
  • 4,
  • 4,
  • 3,
  • 3 and
  • 1, 2
Intensive Care Medicine Experimental20153 (Suppl 1) :A507

https://doi.org/10.1186/2197-425X-3-S1-A507

  • Published:

Keywords

  • Acute Respiratory Distress Syndrome
  • Ventilator Setting
  • Respiratory Mechanic
  • Acute Respiratory Distress Syndrome Patient
  • Quality Improvement Program

Introduction

The amount of pathophysiological impairment in patients with acute respiratory distress syndrome (ARDS) is variable and applying the same ventilator regimen to every patient is questionable. Monitoring of respiratory mechanics for the lung and chest wall allows an individualization of ventilator settings with a potential benefit for the patient. a registry with a large sample size will elicit helpful epidemiological information and may inform future recommendations. We therefore proposed a quality improvement (QI) program constituted by systematic assessment of respiratory mechanics and gas exchange response. the collected data are then introduced into a registry. We report here the preliminary results.

Objectives

The QI program aims at facilitating the integration of respiratory mechanics monitoring in ventilatory management. the primary objective of the registry is to investigate the epidemiology of abnormalities in respiratory mechanics in ARDS patients.

Methods

Two ICUs in Toronto and one ICU in Beijing have initiated this multi-center project. Patients admitted to the ICUs who meet the Berlin definition of ARDS are eligible[1]. Placement of an esophageal catheter is considered when PaO2/FiO2 ≤200. Systematic measurement are performed by the clinicians, including respiratory mechanics, lung and chest wall mechanics, oxygenation response to PEEP, and alveolar derecruitment using a simplified decremental PEEP maneuver[2]. After obtaining the first measurement, a comparison of ventilator settings before and after measurements is conducted and we also report the epidemiology of respiratory mechanics abnormalities observed.

Results

50 ARDS patients have been enrolled (Men: 34, Age: 52 ± 22 years, SOFA: 12 ± 5): 7 patients (14%) had mild ARDS, 33 (66%) moderate ARDS, and 10 (20%) severe ARDS. Esophageal pressure was measured in 46 patients with an occlusion test ratio (ΔPaw/ΔPes) at 0.94 ± 0.18. in 39 patients (78%), the ventilator settings were changed according to measurements, often by limiting VT and PEEP. the physiological variables in respiratory mechanics are described in Table 1. We found that on average 74% of the driving pressure to distend the respiratory system was due to the lung, but with extremes from 48% to 92%. the ICU mortality was 34%.
Table 1

Epidemiology of respiratory mechanics (N = 50).

Variable

Values

Extreme

Unit

Pplat

25 (21-30)

13-37

cmH2O

PEEPtot

12 (10-15)

5-19

cmH2O

Vt/PBW

6.3 (6.0-6.7)

3.0-7.8

ml/kg

Pdriv

13 (9-16)

7-25

cmH2O

Ers

30 (22-37)

16-74

cmH2O/L

EL/Ers

74 (65-80)

48-92

%

PaO2/FiO2, low PEEP*

PaO2/FiO2, high PEEP*

143 (103-190)

142 (118-200)

60-311

58-282

mmHg

mmHg

Vder

120 (69-200)

0-426

ml

Values were described as medians [interquartile ranges], and the extreme was reported as minimum-maximum.

Pplat: plateau pressure; PEEPtot: total PEEP; Vt/PBW, tidal volume per predicted body weight; Pdriv: driving pressure of respiratory system; Ers: elastance of respiratory system; EL/Ers: the ratio of lung elastance to respiratory system elastance; Vder: derecruited volume.

* Assessment of oxygenation response by changing PEEP in 3-5 cmH2O.

Conclusions

A QI program integrating respiratory mechanics monitoring with ventilator management is feasible, lead to individual adaptations and can provide epidemiological information for better understanding respiratory mechanics in ARDS patients.

Authors’ Affiliations

(1)
University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
(2)
St. Michael's Hospital, Keenan Research Centre and Li Ka Shing Insitute, Department of Critical Care, Toronto, Canada
(3)
Beijing Tiantan Hospital, Department of Critical Care Medicine, Beijing, China
(4)
St. Michael's Hospital, Department of Respiratory Therapist, Toronto, Canada

References

  1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al: Acute Respiratory Distress Syndrome the Berlin Definition. JAMA. 2012, 307 (23): 2526-2533.Google Scholar
  2. Dellamonica J, Lerolle N, Sargentini C, Beduneau G, Di Marco F, Mercat A, et al: PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment. Intensive Care Med. 2011, 37 (10): 1595-1604. 10.1007/s00134-011-2333-y.PubMedView ArticleGoogle Scholar

Copyright

© Chen et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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