Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome
Abstract Background In acute respiratory distress syndrome (ARDS) patients, it has recently been proposed to set positive end-expiratory pressure (PEEP) by targeting end-expiratory transpulmonary pressure. This approach, which relies on the measurement of absolute esophageal pressure (Pes), has been...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-09-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-018-0434-2 |
| _version_ | 1818837295583723520 |
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| author | Mehdi Mezidi Francisco José Parrilla Hodane Yonis Zakaria Riad Stephan H. Böhm Andreas D. Waldmann Jean-Christophe Richard Floriane Lissonde Romain Tapponnier Loredana Baboi Jordi Mancebo Claude Guérin |
| author_facet | Mehdi Mezidi Francisco José Parrilla Hodane Yonis Zakaria Riad Stephan H. Böhm Andreas D. Waldmann Jean-Christophe Richard Floriane Lissonde Romain Tapponnier Loredana Baboi Jordi Mancebo Claude Guérin |
| author_sort | Mehdi Mezidi |
| collection | DOAJ |
| description | Abstract Background In acute respiratory distress syndrome (ARDS) patients, it has recently been proposed to set positive end-expiratory pressure (PEEP) by targeting end-expiratory transpulmonary pressure. This approach, which relies on the measurement of absolute esophageal pressure (Pes), has been used in supine position (SP) and has not been investigated in prone position (PP). Our purposes were to assess Pes-guided strategy to set PEEP in SP and in PP as compared with a PEEP/FIO2 table and to explore the early (1 h) and late (16 h) effects of PP on lung and chest wall mechanics. Results We performed a prospective, physiologic study in two ICUs in university hospitals on ARDS patients with PaO2/FIO2 < 150 mmHg. End-expiratory Pes (Pes,ee) was measured in static (zero flow) condition. Patients received PEEP set according to a PEEP/FIO2 table then according to the Pes-guided strategy targeting a positive (3 ± 2 cmH2O) static end-expiratory transpulmonary pressure in SP. Then, patients were turned to PP and received same amount of PEEP from PEEP/FIO2 table then Pes-guided strategy. Respiratory mechanics, oxygenation and end-expiratory lung volume (EELV) were measured after 1 h of each PEEP in each position. For the rest of the 16-h PP session, patients were randomly allocated to either PEEP strategy with measurements done at the end. Thirty-eight ARDS patients (27 male), mean ± SD age 63 ± 13 years, were included. There were 33 primary ARDS and 26 moderate ARDS. PaO2/FIO2 ratio was 120 ± 23 mmHg. At same PEEP/FIO2 table-related PEEP, Pes,ee averaged 9 ± 4 cmH2O in both SP and PP (P = 0.88). With PEEP/FIO2 table and Pes-guided strategy, PEEP was 10 ± 2 versus 12 ± 4 cmH2O in SP and 10 ± 2 versus 12 ± 5 cmH2O in PP (PEEP strategy effect P = 0.05, position effect P = 0.96, interaction P = 0.96). With the Pes-guided strategy, chest wall elastance increased regardless of position. Lung elastance and transpulmonary driving pressure decreased in PP, with no effect of PEEP strategy. Both PP and Pes-guided strategy improved oxygenation without interaction. EELV did not change with PEEP strategy. At the end of PP session, respiratory mechanics did not vary but EELV and PaO2/FIO2 increased while PaCO2 decreased. Conclusions There was no impact of PP on Pes measurements. PP had an immediate improvement effect on lung mechanics and a late lung recruitment effect independent of PEEP strategy. |
| first_indexed | 2024-12-19T03:20:14Z |
| format | Article |
| id | doaj.art-1a2784bdcdd446b5b68040bb53f3c61d |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-19T03:20:14Z |
| publishDate | 2018-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-1a2784bdcdd446b5b68040bb53f3c61d2022-12-21T20:37:46ZengSpringerOpenAnnals of Intensive Care2110-58202018-09-018111010.1186/s13613-018-0434-2Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndromeMehdi Mezidi0Francisco José Parrilla1Hodane Yonis2Zakaria Riad3Stephan H. Böhm4Andreas D. Waldmann5Jean-Christophe Richard6Floriane Lissonde7Romain Tapponnier8Loredana Baboi9Jordi Mancebo10Claude Guérin11Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonIntensive Care Unit, Sant Pau HospitalService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonDepartment of Anesthesiology and Intensive Care Medicine, Rostock University Medical CenterSwisstom AGService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonIntensive Care Unit, Sant Pau HospitalService de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de LyonAbstract Background In acute respiratory distress syndrome (ARDS) patients, it has recently been proposed to set positive end-expiratory pressure (PEEP) by targeting end-expiratory transpulmonary pressure. This approach, which relies on the measurement of absolute esophageal pressure (Pes), has been used in supine position (SP) and has not been investigated in prone position (PP). Our purposes were to assess Pes-guided strategy to set PEEP in SP and in PP as compared with a PEEP/FIO2 table and to explore the early (1 h) and late (16 h) effects of PP on lung and chest wall mechanics. Results We performed a prospective, physiologic study in two ICUs in university hospitals on ARDS patients with PaO2/FIO2 < 150 mmHg. End-expiratory Pes (Pes,ee) was measured in static (zero flow) condition. Patients received PEEP set according to a PEEP/FIO2 table then according to the Pes-guided strategy targeting a positive (3 ± 2 cmH2O) static end-expiratory transpulmonary pressure in SP. Then, patients were turned to PP and received same amount of PEEP from PEEP/FIO2 table then Pes-guided strategy. Respiratory mechanics, oxygenation and end-expiratory lung volume (EELV) were measured after 1 h of each PEEP in each position. For the rest of the 16-h PP session, patients were randomly allocated to either PEEP strategy with measurements done at the end. Thirty-eight ARDS patients (27 male), mean ± SD age 63 ± 13 years, were included. There were 33 primary ARDS and 26 moderate ARDS. PaO2/FIO2 ratio was 120 ± 23 mmHg. At same PEEP/FIO2 table-related PEEP, Pes,ee averaged 9 ± 4 cmH2O in both SP and PP (P = 0.88). With PEEP/FIO2 table and Pes-guided strategy, PEEP was 10 ± 2 versus 12 ± 4 cmH2O in SP and 10 ± 2 versus 12 ± 5 cmH2O in PP (PEEP strategy effect P = 0.05, position effect P = 0.96, interaction P = 0.96). With the Pes-guided strategy, chest wall elastance increased regardless of position. Lung elastance and transpulmonary driving pressure decreased in PP, with no effect of PEEP strategy. Both PP and Pes-guided strategy improved oxygenation without interaction. EELV did not change with PEEP strategy. At the end of PP session, respiratory mechanics did not vary but EELV and PaO2/FIO2 increased while PaCO2 decreased. Conclusions There was no impact of PP on Pes measurements. PP had an immediate improvement effect on lung mechanics and a late lung recruitment effect independent of PEEP strategy.http://link.springer.com/article/10.1186/s13613-018-0434-2Acute respiratory distress syndromeProne positionPositive end-expiratory pressureEsophageal pressureElectrical impedance tomographyTranspulmonary pressure |
| spellingShingle | Mehdi Mezidi Francisco José Parrilla Hodane Yonis Zakaria Riad Stephan H. Böhm Andreas D. Waldmann Jean-Christophe Richard Floriane Lissonde Romain Tapponnier Loredana Baboi Jordi Mancebo Claude Guérin Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome Annals of Intensive Care Acute respiratory distress syndrome Prone position Positive end-expiratory pressure Esophageal pressure Electrical impedance tomography Transpulmonary pressure |
| title | Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| title_full | Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| title_fullStr | Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| title_full_unstemmed | Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| title_short | Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| title_sort | effects of positive end expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome |
| topic | Acute respiratory distress syndrome Prone position Positive end-expiratory pressure Esophageal pressure Electrical impedance tomography Transpulmonary pressure |
| url | http://link.springer.com/article/10.1186/s13613-018-0434-2 |
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