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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

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

Authors: 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

Published in: Critical Care | Issue 1/2017

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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).
Appendix
Available only for authorised users
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Metadata
Title
Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome
Authors
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
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1671-8

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