المؤلفون: Jain, Aditi, Bhardwaj, Neerja, Yaddanapudi, Sandhya, Sen, Indu Mohini, Mathew, Preethy

المصدر: BMC Anesthesiology; 6/22/2024, Vol. 24 Issue 1, p1-11, 11p

مصطلحات موضوعية: CONTINUOUS positive airway pressure, ACADEMIC medical centers, LAPAROSCOPIC surgery, STATISTICAL sampling, ATELECTASIS, TREATMENT effectiveness, RANDOMIZED controlled trials, PNEUMOPERITONEUM, DESCRIPTIVE statistics, MINIMALLY invasive procedures, INTRAOPERATIVE care, LONGITUDINAL method, REACTIVE oxygen species, OXYGEN in the body, ARTIFICIAL respiration, RESPIRATORY measurements, EVALUATION, DISEASE risk factors, CHILDREN

مستخلص: Background: There is a high incidence of pulmonary atelectasis during paediatric laparoscopic surgeries. The authors hypothesised that utilising a recruitment manoeuvre or using continuous positive airway pressure may prevent atelectasis compared to conventional ventilation. Objective: The primary objective was to compare the degree of lung atelectasis diagnosed by lung ultrasound (LUS) using three different ventilation techniques in children undergoing laparoscopic surgeries. Design: Randomised, prospective three-arm trial. Setting: Single institute, tertiary care, teaching hospital. Patients: Children of ASA PS 1 and 2 up to the age of 10 years undergoing laparoscopic surgery with pneumoperitoneum lasting for more than 30 min. Intervention: Random allocation to one of the three study groups: CG group: Inspiratory pressure adjusted to achieve a TV of 5–8 ml/kg, PEEP of 5 cm H2O, respiratory rate adjusted to maintain end-tidal carbon dioxide (ETCO2) between 30-40 mm Hg with manual ventilation and no PEEP at induction. RM group: A recruitment manoeuvre of providing a constant pressure of 30 cm H2O for ten seconds following intubation was applied. A PEEP of 10 cm H2O was maintained intraoperatively. CPAP group: Intraoperative maintenance with PEEP 10 cm H2O with CPAP of 10 cm H2O at induction using mechanical ventilation was done. Outcome measures: Lung atelectasis score at closure assessed by LUS. Results: Post induction, LUS was comparable in all three groups. At the time of closure, the LUS for the RM group (8.6 ± 4.9) and the CPAP group (8.8 ± 6.8) were significantly lower (p < 0.05) than the CG group (13.3 ± 3.8). In CG and CPAP groups, the score at closure was significantly higher than post-induction. The PaO2/FiO2 ratio was significantly higher (p < 0.05) for the RM group (437.1 ± 44.9) and CPAP group (421.6 ± 57.5) than the CG group (361.3 ± 59.4) at the time of pneumoperitoneum. Conclusion: Application of a recruitment manoeuvre post-intubation or CPAP during induction and maintenance with a high PEEP leads to less atelectasis than conventional ventilation during laparoscopic surgery in paediatric patients. Trial registry. CTRI/2019/08/02058. [ABSTRACT FROM AUTHOR]

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المؤلفون: Jung, Boris, Fosset, Maxime, Amalric, Matthieu, Baedorf-Kassis, Elias, O'Gara, Brian, Sarge, Todd, Moulaire, Valerie, Brunot, Vincent, Bourdin, Arnaud, Molinari, Nicolas, Matecki, Stefan

المصدر: Annals of Intensive Care; 6/18/2024, Vol. 14 Issue 1, p1-9, 9p

مصطلحات موضوعية: OBSTRUCTIVE lung disease treatment, BLOOD gases analysis, SEVOFLURANE, RESEARCH funding, CRITICALLY ill, PATIENTS, ACADEMIC medical centers, POSITIVE end-expiratory pressure, INHALATION anesthesia, STATISTICAL sampling, TREATMENT effectiveness, RANDOMIZED controlled trials, DESCRIPTIVE statistics, PROPOFOL, ARTIFICIAL respiration, INTRAVENOUS anesthesia, RESPIRATORY measurements, AIRWAY (Anatomy), RESPIRATORY mechanics, CRITICAL care medicine

مستخلص: Background: The objective was to compare sevoflurane, a volatile sedation agent with potential bronchodilatory properties, with propofol on respiratory mechanics in critically ill patients with COPD exacerbation. Methods: Prospective study in an ICU enrolling critically ill intubated patients with severe COPD exacerbation and comparing propofol and sevoflurane after 1:1 randomisation. Respiratory system mechanics (airway resistance, PEEPi, trapped volume, ventilatory ratio and respiratory system compliance), gas exchange, vitals, safety and outcome were measured at inclusion and then until H48. Total airway resistance change from baseline to H48 in both sevoflurane and propofol groups was the main endpoint. Results: Sixteen patients were enrolled and were sedated for 126 h(61–228) in the propofol group and 207 h(171–216) in the sevoflurane group. At baseline, airway resistance was 21.6cmH2O/l/s(19.8–21.6) in the propofol group and 20.4cmH2O/l/s(18.6–26.4) in the sevoflurane group, (p = 0.73); trapped volume was 260 ml(176–290) in the propofol group and 73 ml(35–126) in the sevoflurane group, p = 0.02. Intrinsic PEEP was 1.5cmH2O(1–3) in both groups after external PEEP optimization. There was neither early (H4) or late (H48) significant difference in airway resistance and respiratory mechanics parameters between the two groups. Conclusions: In critically ill patients intubated with COPD exacerbation, there was no significant difference in respiratory mechanics between sevoflurane and propofol from inclusion to H4 and H48. [ABSTRACT FROM AUTHOR]

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المؤلفون: Lin, Chi‐Wei, Liu, Huei‐Mei, Liu, Chieh‐Yu, Chu, Yen‐Hung, Wang, Shou‐Tzu, Chen, Chi‐Wen

المصدر: Nursing in Critical Care; May2024, Vol. 29 Issue 3, p521-531, 11p

مصطلحات موضوعية: HEEL (Anatomy), OXYGEN saturation, T-test (Statistics), RESEARCH funding, STATISTICAL sampling, KRUSKAL-Wallis Test, PARENT attitudes, RANDOMIZED controlled trials, CHI-squared test, DESCRIPTIVE statistics, OPERATIVE surgery, NEWBORN infants, HEART beat, PAIN, RESPIRATORY measurements, ONE-way analysis of variance, HUMAN voice, PSYCHOLOGY of parents, COMPARATIVE studies, DATA analysis software

مستخلص: Background: High‐risk newborns, such as premature or severely ill infants, often experience painful treatments and separation from their parents. While previous studies have focused on the positive impacts of a mother's voice on newborns' physiology and pain response, research on the father's voice and vocal acoustics in high‐risk newborns is limited. Aim: To examine whether parents' voices reduce heel puncture pain in high‐risk newborns and the relationship between parents' vocal acoustics, physiological parameters and pain response. Study Design: A randomized controlled clinical trial was conducted with 105 high‐risk newborn–parent dyads. Participants were randomly assigned to three groups: recorded mother's voice, recorded father's voice or control group without any recorded voice. Outcome measures included heart rate, respiratory rate, oxygen saturation and pain response assessed using the Neonatal Infant Pain Scale. Data analysis utilized generalized estimation equations, and parents' vocal acoustics were analysed using Praat voice credit software. Results: The mother's voice group exhibited significantly lower heart rates at 1, 5 and 10 min after the procedure, along with lower respiratory rates and pain levels at 5 and 10 min after the procedure compared with the control group. Similarly, the father's voice group demonstrated significantly lower heart rates at 1 and 5 min after the procedure, decreased respiratory rates at 5 and 10 min after the procedure and reduced pain levels at 1 and 5 to 10 min after the procedure compared with the control group. Higher minimum and mean pitches in parents' voices correlated with slower heart rates, while slower parental speech was associated with reduced newborn pain. Conclusion: Both maternal and paternal vocal interventions alleviated pain during heel puncture procedures among high‐risk newborns. Relevance to Clinical Practice: The noninvasive intervention serves as a reference for parental participation in care. Nurses can help parents to intervene with the acoustic characteristics that alleviate pain among high‐risk newborns. [ABSTRACT FROM AUTHOR]

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المؤلفون: Li-Ya Chiang, Jung-Mei Tsai, Chin-Hsing Chen, Li-Yun Tsai

المصدر: International Journal of Gerontology; Apr2024, Vol. 18 Issue 2, p96-102, 7p

مصطلحات موضوعية: PREVENTION of mental depression, EXERCISE physiology, LIFESTYLES, OXYGEN saturation, SELF-evaluation, COMPRESSION bandages, EARLY medical intervention, STATISTICAL sampling, RESEARCH evaluation, QUESTIONNAIRES, RANDOMIZED controlled trials, DESCRIPTIVE statistics, CHI-squared test, RESISTANCE training, NURSING care facilities, CONTROL groups, PRE-tests & post-tests, HEART beat, EXPERIMENTAL design, QUALITY of life, RESPIRATORY measurements, COMPARATIVE studies, BLOOD pressure, DATA analysis software, GRIP strength, OLD age

مصطلحات جغرافية: TAIWAN

مستخلص: Background: Sedentary activities are not conducive to the health benefits of elderly residents living in nursing homes. This study explored the effect of a 12-week elastic band resistance exercise (EBRE) on physical function, depression and quality of life (QOL) among the elderly in nursing homes. Methods: A single-blind experimental design. Eighty elderly from three nursing homes in the south of Taiwan were selected and assigned to the control group (40) and the experimental group (40). The experimental group intervened with regular EBRE for 12weeks. The control group maintained the original lifestyle and activity. Physiological status, depression and QOL were assessed using tools and instruments with reliability and validity at weeks 4, 8, and 12 during the study period. Results: After the 12-week EBRE intervention, the grip strength, one of the physiological indicators, was significantly improved at weeks 4, 8 and 12 (p < 0.05) with the experimental group. The measured blood oxygen saturation, heart rate, respiratory rate and blood pressure were non-affected. Self-reported depression and QOL were improved (p < 0.001) significantly at week 12. Conclusion: Early intervention of EBRE is an effective method to improve grip strength and QOL and to reduce depression for the elderly living in nursing homes. The results provide empirical evidence for incorporating EBRE into regular activity in nursing homes. [ABSTRACT FROM AUTHOR]

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المؤلفون: Gomes dos Santos, Ewerton Graziane, Vieira da Costa, Karina, Cordeiro de Souza, Iara Tainá, Victor dos Santos Felix, João, Furtado Brandão, Celso Brendo, Michelle de Souza Fernandes, Vanessa, Lugon Favero, Andressa Bomfim, Lucrécia de Aquino Gouveia, Maria, Tavares de Lima, Dyego, Heriston de Morais Lima, José, Pedrosa, Rafaela, Alves de Oliveira, Valéria Mayaly, da Cruz Santos, Amilton, Gama, Tatiana Onofre, Guedes de Brito, Geraldo Eduardo, Tenório de França, Eduardo Eriko

المصدر: Physiotherapy Research International; Apr2024, Vol. 29 Issue 2, p1-9, 9p

مصطلحات موضوعية: MEDICAL protocols, MYALGIA, ACADEMIC medical centers, BODY mass index, DATA analysis, QUALITATIVE research, PATIENTS, CHEST pain, FATIGUE (Physiology), BODY composition, POST-acute COVID-19 syndrome, STATISTICAL sampling, HOSPITAL care, HOSPITAL admission & discharge, FUNCTIONAL status, RANDOMIZED controlled trials, BIOELECTRIC impedance, DESCRIPTIVE statistics, CHI-squared test, QUANTITATIVE research, CARDIOPULMONARY system, MUSCLE strength, LUNG diseases, MEDICAL rehabilitation, EXERCISE tolerance, RESPIRATORY measurements, AEROBIC exercises, STATISTICS, DYSPNEA, AIRWAY (Anatomy), EXERCISE tests, DATA analysis software, CONFIDENCE intervals, SMELL disorders, AGEUSIA, CARDIAC rehabilitation, MEMORY disorders

مستخلص: Background and Objective: Reduced functional capacity, dyspnea, fatigue, and changes in body composition are common in patients with post‐COVID‐19 syndrome (PCS), and cardiopulmonary rehabilitation may improve these parameters. Thus, the present study verified the effects of cardiopulmonary rehabilitation (respiratory, aerobic, and resistance muscle training) on submaximal exercise tolerance, dyspnea, fatigue, and body composition. Methods: This controlled and randomized clinical trial applied a six‐week outpatient intervention protocol in individuals over 18 years old (n = 33) with a diagnosis of COVID‐19 confirmed by polymerase chain reaction. These individuals were allocated to cardiopulmonary rehabilitation (n = 17) or control groups (i.e., educational lectures; n = 16). The cardiopulmonary rehabilitation group performed respiratory, aerobic, and resistance muscle training. Submaximal exercise tolerance, dyspnea, fatigue, and body composition were assessed before and after the protocol. Results: After 6 weeks, the cardiopulmonary rehabilitation group increased the tolerance to submaximal exercise, with a difference of 100.46 m (95% confidence interval [CI]: 7.40–193 m) in the distance walked on the six‐minute walk test, reduced dyspnea (−1.45, 95% CI: −1.98–−0.92) in the modified Medical Research Council, and increased 0.63 kg (95% CI: 0.09–1.18 kg) of muscle mass in the upper limbs compared with the control group. Conclusion: The six‐week cardiopulmonary rehabilitation protocol improved functional capacity, reduced dyspnea, and increased muscle mass in the upper limbs in individuals with PCS. Thus, these results supported the protocol use in this population and encourage further studies to assess its effectiveness in a large sample. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bilgili, Sumeyye, Balci Akpinar, Reva

المصدر: Nursing in Critical Care; Mar2024, Vol. 29 Issue 2, p357-365, 9p

مصطلحات موضوعية: MUSIC, CONTINUOUS positive airway pressure, PATIENT compliance, OXYGEN saturation, STATISTICAL power analysis, REPEATED measures design, CRITICALLY ill, PATIENTS, T-test (Statistics), RESEARCH funding, LISTENING, AGITATION (Psychology), RANDOMIZED controlled trials, CHI-squared test, GLASGOW Coma Scale, LONGITUDINAL method, INTENSIVE care units, RESPIRATORY measurements, HEALTH outcome assessment, DATA analysis software, COVID-19

مصطلحات جغرافية: TURKEY

مستخلص: Background: Agitation and incompliance with the treatment may be observed in patients undergoing continuous positive airway pressure (CPAP), which may cause inadequate oxygenation, sedation, termination of CPAP or intubation of the patient. Aim: This study was conducted to determine the effect of listening to music during CPAP on the agitation levels of intensive care patients who underwent CPAP as a result of COVID‐19 and their compliance with the treatment. Study design: This study was a prospective, randomized, controlled clinical trial. Seventy‐six intensive care patients with COVID‐19 were included in this study and assigned to the music and control groups via the block randomization method. The study was completed with 70 patients. The patients and outcome assessors were not blinded in this study. The Richmond Agitation and Sedation Scale (RASS) level, respiratory rate, oxygen saturation (SpO2) and mask air leakage amount were the outcome measures. Results: The mean RASS score of the patients in the intervention group was 2.14 ± 0.69 before CPAP, 1.63 ± 064 at the 1st minute, 0.89 ± 0.58 at the 15th minute and 0.74 ± 0.61 at the 30th minute. The mean RASS score of the patients in the control group was 2.06 ± 0.53 before CPAP, 1.80 ± 0.58 at the 1st minute, 1.43 ± 0.60 at the 15th minute and 1.46 ± 0.61 at the 30th minute of CPAP. There was a statistically significant difference between the groups at the 15th and 30th minutes (t = −3.81, p <.001; t = −4.89, p <.001 respectively). The mean respiratory rate, SpO2 and mask air leakage amount were compared between the groups. There was a statistically significant difference in favour of the intervention group at the 15th minute (t = −2.47, p <.001; t = 2.57, p <.001; t = 2.93, p <.001 respectively) and 30th minute (t = −3.17, p <.001; t = 3.46, p <.001; t = −3.93, p <.001 respectively). Conclusions: The study results show that listening to music during CPAP reduces the agitation levels of patients and helps them comply with the treatment. Relevance to clinical practice: Music may be a beneficial application for patients who are agitated and unable to comply with CPAP therapy. This is an easy and applicable method, which can protect patients from the adverse effects of failed CPAP. [ABSTRACT FROM AUTHOR]

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المؤلفون: Park, Sihwa, Kim, Young‐Chul, Jee, Yong‐Seok

المصدر: European Journal of Sport Science; Mar2024, Vol. 24 Issue 3, p330-340, 11p

مصطلحات موضوعية: SYMPATHETIC nervous system physiology, PHYSIOLOGY of abdominal muscles, AUTONOMIC nervous system physiology, EXERCISE physiology, BIOMECHANICS, EXERCISE therapy, RESPIRATION, BODY composition, STATISTICAL sampling, DESCRIPTIVE statistics, RANDOMIZED controlled trials, EXPIRATORY flow, HEART beat, FORCED expiratory volume, RESPIRATORY measurements, MUSCLE contraction

مستخلص: This research aimed to explore the impact of plank exercise training (PET) on respiratory function, body composition, abdominis performance, and autonomic nervous system (ANS). Sixty‐one young adults participated and were divided into a control group (CG, n = 31) and an exercise group (EG, n = 30), wherein PET was administered 3 days per week for 12 weeks. After the experiment, the body composition of the CG deteriorated, whereas that of the EG improved (p < 0.001). The EG exhibited a reduction of ∼34% in the mean maximum displacement and a rise of ∼20% in the mean contraction time of the abdominis. The sit‐up in the EG demonstrated a significant increase of ∼55%. In the EG, there was a substantial increase in peak expiratory force by ∼24% and forced expiratory volume in 1 s by ∼14%, accompanied by a reduction in resting respiratory rate by ∼ −9%. When compared to the CG, these alterations were significant between the two groups (p = 0.001). In the EG, there was a significant decrease in resting heart rate by ∼2%, accompanied by a decrease in sympathetic nervous activity by ∼ −5% and by an increase in parasympathetic nervous activity by ∼5%. When compared to the CG, these alterations were significant between the two groups (p = 0.001). The findings of this study revealed that implementing PET in young adults, while controlling for dietary intake and physical activity, resulted in noteworthy changes in respiratory capacity. These changes were coupled with improvements in body composition, abdominal functions, and the ANS. Highlights: The plank exercise training (PET) resulted in a decrease in body weight, fat mass, body mass index, and waist‐to‐hip ratio, along with an increase in muscle mass over a 12‐week period.The PET led to a decrease in the maximum displacement and an increase in the contraction time, along with an improvement in abdominal muscle endurance.The peak expiratory flow and forced expiratory volume in 1 s exhibited increases as a result of the PET, accompanied by a notable decrease in resting respiratory rate.The PET led to a reduction in resting heart rate, influenced by a decrease in sympathetic nervous activity and an increase in parasympathetic nervous activity. [ABSTRACT FROM AUTHOR]

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المؤلفون: González, Alma Patricia, Loredo Aguayo, Claudia Helena, Barbosa Sabanero, Gloria, Vasquez Mendoza, Ma Guadalupe, Aguiñaga Zamarripa, Ma de La Luz, Linares Salas, Victor Hugo, Sosa Bustamante, Gloria Patricia

المصدر: Journal of Integrative & Complementary Medicine; Feb2024, Vol. 30 Issue 2, p165-172, 8p

مصطلحات موضوعية: SALIVA analysis, HUMAN growth, NONPARAMETRIC statistics, INFANT care, MASSAGE therapy, NEONATAL intensive care, ANALYSIS of variance, CONFIDENCE intervals, FOOD consumption, GESTATIONAL age, RESPIRATORY measurements, MANN Whitney U Test, OXYGEN saturation, RANDOMIZED controlled trials, IMMUNOASSAY, WEIGHT gain, T-test (Statistics), ENZYME-linked immunosorbent assay, HEART beat, DESCRIPTIVE statistics, STATISTICAL sampling, DATA analysis software, HYDROCORTISONE, STRESS in children, PATIENT safety, CHILDREN

مستخلص: Background: In neonatal intensive care units across the world, premature neonates are exposed to a very stressful environment with high levels of noise, bright lights, pain, infections, invasive procedures, and a lack of maternal contact. Stress is manifested by increased cortisol levels and clinical signs of stress. Objective: To assess the impact of Vimala massage on (1) salivary cortisol levels (primary outcome) and (2) clinical signs of stress (secondary outcomes) in premature neonates. Methods: Neonates (28–36 weeks gestational age) admitted to a nursery unit were randomized one-to-one to receive 15–20 min of Vimala massage administered by their parents twice daily and usual care, or to usual care alone. Salivary cortisol levels were measured by enzyme-linked immunosorbent assay (ELISA) on days 1 and 5. Heart rate, respiratory rate, caloric intake, weight gain, and growth were recorded daily. Groups were compared with t tests, U-tests, and repeated measures analysis of variance. Results: Seventy neonates, 35 in each group, were included. Groups were comparable at baseline. The median decrease in salivary cortisol levels was 0.12 μg/dL in the massage group and 0.07 μg/dL in the control group (p = 0.22). Over 5 days, the massage group had significant decreases in resting heart rate (p = 0.003) and respiratory rate (p = 0.028), and greater weight gains (p = 0.0002), relative to controls. Conclusions: In this randomized trial, adding Vimala massage to usual nursery care was not associated with a significant decrease in salivary cortisol levels in premature neonates, when compared with usual nursery care alone. There were improvements in clinical signs of stress. [ABSTRACT FROM AUTHOR]

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المؤلفون: Wang, Xiaodong, Ma, Lian, Yang, Xudong, Zhou, Yi, Zhang, Xiang, Han, Fang

المصدر: BMC Anesthesiology; 1/2/2024, Vol. 24 Issue 1, p1-8, 8p

مصطلحات موضوعية: ANALYSIS of variance, CLEFT palate, RESPIRATORY measurements, IMIDAZOLES, CLEFT lip, TREATMENT effectiveness, RANDOMIZED controlled trials, T-test (Statistics), INTRANASAL administration, RESEARCH funding, REPEATED measures design, CHI-squared test, HEART beat, MIDAZOLAM, COMPUTED tomography, STATISTICAL sampling, HEMODYNAMICS, ADVERSE health care events, PHARMACODYNAMICS

مستخلص: Background: There is a great challenge to sedation for infants with cleft lip and palate undergoing CT scan, because there is the younger age and no consensus on the type, dosage, and route of drug administration. Objective: This study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate under imaging procedures. Methods: Infants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography (CT) scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time, Ramsay sedation scale, hemodynamic parameters during sedation, and adverse events. Data analyses involved the unpaired t-test, the repeated-measures analysis of variance test, and the continuity correction χ2 test. Results: One hundred five infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). The difference in Ramsay sedation scale values 20 min after administration was statistically significant between the groups. No statistically significant difference was found between the groups in changes in heart rate and respiratory rate. Conclusion: Intranasal administration of dexmedetomidine in combination with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. However, it has a relatively prolonged duration of sedation and recovery time. Trial registration: ChiCTR2100049122, Clinical trial first registration date: 21/07/2021. [ABSTRACT FROM AUTHOR]

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المؤلفون: Docci, Mattia, Rezoagli, Emanuele, Teggia-Droghi, Maddalena, Coppadoro, Andrea, Pozzi, Matteo, Grassi, Alice, Bianchi, Isabella, Foti, Giuseppe, Bellani, Giacomo

المصدر: Annals of Intensive Care; 12/20/2023, Vol. 13 Issue 1, p1-9, 9p

مصطلحات موضوعية: RESPIRATORY muscle physiology, RESPIRATORY muscles, PRESSURE breathing, RESPIRATORY insufficiency, CONFIDENCE intervals, RESPIRATORY measurements, ARTIFICIAL respiration, BODY surface area, PEARSON correlation (Statistics), RANDOMIZED controlled trials, DESCRIPTIVE statistics, RESEARCH funding, RESPIRATION, ELECTROMYOGRAPHY, STATISTICAL sampling, BODY mass index, RESPIRATORY mechanics

مستخلص: Background: During Pressure Support Ventilation (PSV) an inspiratory hold allows to measure plateau pressure (Pplat), driving pressure (∆P), respiratory system compliance (Crs) and pressure-muscle-index (PMI), an index of inspiratory effort. This study aims [1] to assess systematically how patient's effort (estimated with PMI), ∆P and tidal volume (Vt) change in response to variations in PSV and [2] to confirm the robustness of Crs measurement during PSV. Methods: 18 patients recovering from acute respiratory failure and ventilated by PSV were cross-randomized to four steps of assistance above (+ 3 and + 6 cmH2O) and below (-3 and -6 cmH2O) clinically set PS. Inspiratory and expiratory holds were performed to measure Pplat, PMI, ∆P, Vt, Crs, P0.1 and occluded inspiratory airway pressure (Pocc). Electromyography of respiratory muscles was monitored noninvasively from body surface (sEMG). Results: As PSV was decreased, Pplat (from 20.5 ± 3.3 cmH2O to 16.7 ± 2.9, P < 0.001) and ∆P (from 12.5 ± 2.3 to 8.6 ± 2.3 cmH2O, P < 0.001) decreased much less than peak airway pressure did (from 21.7 ± 3.8 to 9.7 ± 3.8 cmH2O, P < 0.001), given the progressive increase of patient's effort (PMI from -1.2 ± 2.3 to 6.4 ± 3.2 cmH2O) in line with sEMG of the diaphragm (r = 0.614; P < 0.001). As ∆P increased linearly with Vt, Crs did not change through steps (P = 0.119). Conclusion: Patients react to a decrease in PSV by increasing inspiratory effort—as estimated by PMI—keeping Vt and ∆P on a desired value, therefore, limiting the clinician's ability to modulate them. PMI appears a valuable index to assess the point of ventilatory overassistance when patients lose control over Vt like in a pressure-control mode. The measurement of Crs in PSV is constant—likely suggesting reliability—independently from the level of assistance and patient's effort. [ABSTRACT FROM AUTHOR]

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