This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Purpose: Driving pressure (ΔP) and mechanical power (MP) may be important mediators of lung injury in acute respiratory distress syndrome (ARDS) however there is little evidence for strategies directed at lowering these parameters. We applied predictive modeling to estimate the effects of modifying ventilator parameters on ΔP and MP.
Methods: 2,622 ARDS patients (Berlin criteria) from the Medical Information Mart for Intensive Care IV database (MIMIC-IV version1.0) admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center between 2008 and 2019 were included. Flexible confounding-adjusted regression models for time varying data were fit to estimate the effects of adjusting PEEP and tidal volume (VT) on ΔP, and adjusting VT and respiratory rate (f) on MP.
Results: Reduction in VT reduced ΔP and MP, with more pronounced effect on MP with lower compliance. Strategies reducing f, consistently increased MP (when VT was adjusted to maintain consistent minute ventilation). Adjustment of PEEP yielded a U-shaped effect on ΔP.
Conclusions: This novel conditional modeling confirmed expected response patterns for ΔP, with the response to adjustments depending on patients’ lung mechanics. Furthermore a VT -driven approach should be favored over a f -driven approach when aiming to reduce MP.
- Acute Respiratory Distress Syndrome
- ARDS
- Driving Pressure
- Mechanical Power
- Power
- Mechanical Ventilation
- PEEP
- Positive end expiratory pressure
- Tidal volume
- modeling
Footnotes
- Corresponding Author: Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, 02115. Email: enbaedor{at}bidmc.harvard.edu
- Received May 5, 2022.
- Accepted July 19, 2022.
- Copyright © 2022 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.