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Article Dans Une Revue (Data Paper) Critical Care Année : 2023

A novel method for assessment of airway opening pressure without the need for low-flow insufflation

Résumé

Background Airway opening pressure (AOP) detection and measurement are essential for assessing respiratory mechanics and adapting ventilation. We propose a novel approach for AOP assessment during volume assist control ventilation at a usual constant-flow rate of 60 L/min. Objectives To validate the conductive pressure (P cond) method, which compare the P cond-defined on the airway pressure waveform as the difference between the airway pressure level at which an abrupt change in slope occurs at the beginning of insufflation and PEEP-to resistive pressure for AOP detection and measurement, and to compare its respiratory and hemodynamic tolerance to the standard low-flow insufflation method. Methods The proof-of-concept of the P cond method was assessed on mechanical (lung simulator) and physiological (cadavers) bench models. Its diagnostic performance was evaluated in 213 patients, using the standard low-flow insufflation method as a reference. In 45 patients, the respiratory and hemodynamic tolerance of the P cond method was compared with the standard low-flow method. Measurements and main results Bench assessments validated the P cond method proof-of-concept. Sensitivity and specificity of the P cond method for AOP detection were 93% and 91%, respectively. AOP obtained by P cond and standard low-flow methods strongly correlated (r = 0.84, p < 0.001). Changes in SpO 2 were significantly lower during P cond than during standard method (p < 0.001). Conclusion Determination of P cond during constant-flow assist control ventilation may permit to easily and safely detect and measure AOP.
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inserm-04169664 , version 1 (24-07-2023)

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Anne-Fleur Haudebourg, Elsa Moncomble, Arnaud Lesimple, Flora Delamaire, Bruno Louis, et al.. A novel method for assessment of airway opening pressure without the need for low-flow insufflation. Critical Care, 2023, 27 (1), pp.273. ⟨10.1186/s13054-023-04560-0⟩. ⟨inserm-04169664⟩
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