TY - JOUR
T1 - Effect of endotracheal tube size, respiratory system mechanics, and ventilator settings on driving pressure
AU - Ilia, Stavroula
AU - van Schelven, Patrick D.
AU - Koopman, Alette A.
AU - Blokpoel, Robert G.T.
AU - de Jager, Pauline
AU - Burgerhof, Johannes G.M.
AU - Markhorst, Dick G.
AU - Kneyber, Martin C.J.
PY - 2020/1
Y1 - 2020/1
N2 - Objectives: We sought to investigate factors that affect the difference between the peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions (resistive pressure) during pressure controlled ventilation across a range of endotracheal tube sizes, respiratory mechanics, and ventilator settings. Design: In vitro study. Setting: Research laboratory. Patients: None. Interventions: An in vitro bench model of the intubated respiratory system during pressure controlled ventilation was used to obtain the difference between peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions across a range of endotracheal tubes sizes (3.0–8.0 mm). Measurements were taken at combinations of pressure above positive end-expiratory pressure (10, 15, and 20 cm H2O), airway resistance (no, low, high), respiratory system compliance (ranging from normal to extremely severe), and inspiratory time at constant positive end-expiratory pressure (5 cm H2O). Multiple regression analysis was used to construct models predicting resistive pressure stratified by endotracheal tube size. Measurements and Main Results: On univariate regression analysis, respiratory system compliance (β –1.5; 95% CI, –1.7 to –1.4; p < 0.001), respiratory system resistance (β 1.7; 95% CI, 1.5–2.0; p < 0.001), pressure above positive end-expiratory pressure (β 1.7; 95% CI, 1.4–2.0; p < 0.001), and inspiratory time (β –0.7; 95% CI, –1.0 to –0.4; p < 0.001) were associated with resistive pressure. Multiple linear regression analysis showed the independent association between increasing respiratory system compliance, increasing airway resistance, increasing pressure above positive end-expiratory pressure, and decreasing inspiratory time and resistive pressure across all endotracheal tube sizes. Inspiratory time was the strongest variable associated with a proportional increase in resistive pressure. The contribution of airway resistance became more prominent with increasing endotracheal tube size. Conclusions: Peak inspiratory pressures measured during pressure controlled ventilation overestimated plateau pressure irrespective of endotracheal tube size, especially with decreased inspiratory time or increased airway resistance.
AB - Objectives: We sought to investigate factors that affect the difference between the peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions (resistive pressure) during pressure controlled ventilation across a range of endotracheal tube sizes, respiratory mechanics, and ventilator settings. Design: In vitro study. Setting: Research laboratory. Patients: None. Interventions: An in vitro bench model of the intubated respiratory system during pressure controlled ventilation was used to obtain the difference between peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions across a range of endotracheal tubes sizes (3.0–8.0 mm). Measurements were taken at combinations of pressure above positive end-expiratory pressure (10, 15, and 20 cm H2O), airway resistance (no, low, high), respiratory system compliance (ranging from normal to extremely severe), and inspiratory time at constant positive end-expiratory pressure (5 cm H2O). Multiple regression analysis was used to construct models predicting resistive pressure stratified by endotracheal tube size. Measurements and Main Results: On univariate regression analysis, respiratory system compliance (β –1.5; 95% CI, –1.7 to –1.4; p < 0.001), respiratory system resistance (β 1.7; 95% CI, 1.5–2.0; p < 0.001), pressure above positive end-expiratory pressure (β 1.7; 95% CI, 1.4–2.0; p < 0.001), and inspiratory time (β –0.7; 95% CI, –1.0 to –0.4; p < 0.001) were associated with resistive pressure. Multiple linear regression analysis showed the independent association between increasing respiratory system compliance, increasing airway resistance, increasing pressure above positive end-expiratory pressure, and decreasing inspiratory time and resistive pressure across all endotracheal tube sizes. Inspiratory time was the strongest variable associated with a proportional increase in resistive pressure. The contribution of airway resistance became more prominent with increasing endotracheal tube size. Conclusions: Peak inspiratory pressures measured during pressure controlled ventilation overestimated plateau pressure irrespective of endotracheal tube size, especially with decreased inspiratory time or increased airway resistance.
KW - Driving pressure
KW - In vitro techniques
KW - Mechanical ventilation
KW - Pediatric intensive care unit
KW - Pressure controlled ventilation
KW - Resistive pressure
UR - http://www.scopus.com/inward/record.url?scp=85077475605&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/PCC.0000000000002186
DO - https://doi.org/10.1097/PCC.0000000000002186
M3 - Article
C2 - 31688716
SN - 1529-7535
SP - E47-E51
JO - Pediatric critical care medicine
JF - Pediatric critical care medicine
ER -