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Research ArticleOriginal Research

Elastic Power of Mechanical Ventilation in Morbid Obesity and Severe Hypoxemia

Muhammad K Hayat Syed, John Selickman, Michael D Evans, David Dries and John J Marini
Respiratory Care April 2021, 66 (4) 626-634; DOI: https://doi.org/10.4187/respcare.08234
Muhammad K Hayat Syed
Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota.
Department of Medicine, Regions Hospital, Saint Paul, Minnesota.
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John Selickman
Department of Medicine, Regions Hospital, Saint Paul, Minnesota.
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Michael D Evans
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota.
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David Dries
Department of Surgery, Regions Hospital, Saint Paul, Minnesota.
Department of Critical Care and Acute Care Surgery, University of Minnesota, Minnesota.
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John J Marini
Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota.
Department of Medicine, Regions Hospital, Saint Paul, Minnesota.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: To minimize ventilator-induced lung injury, the primary clinical focus is currently expanding from measuring static indices of the individual tidal cycle (eg, plateau pressure and tidal volume) to more inclusive indicators of energy load, such as total power and its elastic components. Morbid obesity may influence these components. We characterized the relative values of elastic subcomponents of total power (ie, driving power and dynamic power) in subjects with severe hypoxemia, morbid obesity, or their combination.

METHODS: We analyzed data from subjects receiving mechanical ventilation divided into 4 groups. Embedded Image/Embedded Image < 150 mm Hg (severe hypoxemia) indicated probable reduction of lung compliance while body mass index > 40 kg/m2 (morbid obesity) suggested a possible contribution to reduced respiratory system compliance from the chest wall. Group 1 included subjects with no expected abnormality of lung compliance or chest wall compliance; Group 2 included subjects with expected reduction of lung compliance on the basis of severe hypoxemia but with no morbid obesity; Group 3 included subjects with morbid obesity without severe hypoxemia; and Group 4 included subjects with morbid obesity and severe hypoxemia. All ventilator-induced lung injury predictors were compared among groups using mixed-effects linear models.

RESULTS: Groups 1–4 included 61, 52, 49, and 51 subjects, respectively. Mean body mass index averaged 28.7 kg/m2 for nonobese subjects and 52.1 kg/m2 for morbidly obese subjects. Mean driving pressure, dynamic power, and driving power of Groups 2 and 3 exceeded the corresponding values of Group 1 but fell into similar ranges when compared with each other. These values were highest in Group 4 subjects. In Group 2, mean dynamic power and driving power values were comparable to those in Group 3.

CONCLUSIONS: In mechanically ventilated subjects, stress and energy-based ventilator-induced lung injury indicators are influenced by the relative contributions of chest wall and lung to overall respiratory mechanics. Numerical guidelines for ventilator-induced lung injury risk must strongly consider adjustment for these elastic characteristics in morbid obesity.

  • mechanical ventilation
  • ventilator-induced lung injury
  • elastic power of ventilation
  • morbid obesity
  • hypoxemia
  • ARDS
  • respiratory compliance

Footnotes

  • Correspondence: John J Marini MD. E-mail: marin002{at}umn.edu
  • Dr Hayat Syed presented a version of this paper at the 49th Annual Meeting of the Society of Critical Care Medicine, held February 16–20, 2020, in Orlando, Florida.

  • This research was partly supported by the National Institutes of Health’s National Center for Advancing Translational Sciences (grant UL1TR002494) and the Regions Hospital Research, Education, and Development Fund. The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (4)
Respiratory Care
Vol. 66, Issue 4
1 Apr 2021
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Elastic Power of Mechanical Ventilation in Morbid Obesity and Severe Hypoxemia
Muhammad K Hayat Syed, John Selickman, Michael D Evans, David Dries, John J Marini
Respiratory Care Apr 2021, 66 (4) 626-634; DOI: 10.4187/respcare.08234

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Elastic Power of Mechanical Ventilation in Morbid Obesity and Severe Hypoxemia
Muhammad K Hayat Syed, John Selickman, Michael D Evans, David Dries, John J Marini
Respiratory Care Apr 2021, 66 (4) 626-634; DOI: 10.4187/respcare.08234
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Keywords

  • mechanical ventilation
  • ventilator-induced lung injury
  • elastic power of ventilation
  • morbid obesity
  • hypoxemia
  • ARDS
  • respiratory compliance

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