دورية أكاديمية

Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome

التفاصيل البيبلوغرافية
العنوان: Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome
المؤلفون: Lu Chen, Guang-Qiang Chen, Kevin Shore, Orest Shklar, Concetta Martins, Brian Devenyi, Paul Lindsay, Heather McPhail, Ashley Lanys, Ibrahim Soliman, Mazin Tuma, Michael Kim, Kerri Porretta, Pamela Greco, Hilary Every, Chris Hayes, Andrew Baker, Jan O. Friedrich, Laurent Brochard
المصدر: Critical Care, Vol 21, Iss 1, Pp 1-11 (2017)
بيانات النشر: BMC, 2017.
سنة النشر: 2017
المجموعة: LCC:Medical emergencies. Critical care. Intensive care. First aid
مصطلحات موضوعية: Pulmonary function test, Respiratory physiology, Esophageal pressure, Mechanical ventilation, Quality improvement, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
الوصف: Abstract Background Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test. Methods The respiratory mechanics assessment constituted a set of bedside measurements to determine passive lung and chest wall mechanics, response to positive end-expiratory pressure, and alveolar derecruitment. It was obtained early after ARDS diagnosis. The results were provided to the clinical team to be used at their own discretion. We compared ventilator settings and physiological variables before and after the test. The physiological endpoints were oxygenation index, dead space, and plateau and driving pressures. Results Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by switching pressure-targeted mode to volume-targeted mode. Following changes, the oxygenation index, airway plateau, and driving pressures were significantly improved, whereas the dead-space fraction remained unchanged. The oxygenation index continued to improve in the next 48 h. Conclusions Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. Trial registration The present study involves data from our ongoing registry for respiratory mechanics (ClinicalTrials.gov identifier: NCT02623192 . Registered 30 July 2015).
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 1364-8535
Relation: http://link.springer.com/article/10.1186/s13054-017-1671-8; https://doaj.org/toc/1364-8535
DOI: 10.1186/s13054-017-1671-8
URL الوصول: https://doaj.org/article/1863269e89f14d7cb59883d393e33671
رقم الأكسشن: edsdoj.1863269e89f14d7cb59883d393e33671
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:13648535
DOI:10.1186/s13054-017-1671-8