Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial
OBJECTIVES: Lung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams and Wilkins
2022
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| _version_ | 1797108358832979968 |
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| author | de Vries, HJ Jonkman, AH de Grooth, HJ Duitman, JW Girbes, ARJ Ottenheijm, CAC Schultz, MJ van de Ven, PM Zhang, Y de Man, AME Tuinman, PR Heunks, LMA |
| author_facet | de Vries, HJ Jonkman, AH de Grooth, HJ Duitman, JW Girbes, ARJ Ottenheijm, CAC Schultz, MJ van de Ven, PM Zhang, Y de Man, AME Tuinman, PR Heunks, LMA |
| author_sort | de Vries, HJ |
| collection | OXFORD |
| description | OBJECTIVES:
Lung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes diaphragm atrophy, whereas excessive breathing effort induces diaphragm and lung injury. In a proof-of-concept study, we aimed to assess whether titration of inspiratory support based on diaphragm effort increases the time that patients have effort in a predefined “diaphragm-protective” range, without compromising lung-protective ventilation.
DESIGN:
Randomized clinical trial.
SETTING:
Mixed medical-surgical ICU in a tertiary academic hospital in the Netherlands.
PATIENTS:
Patients (n = 40) with respiratory failure ventilated in a partially-supported mode.
INTERVENTIONS:
In the intervention group, inspiratory support was titrated hourly to obtain transdiaphragmatic pressure swings in the predefined “diaphragm-protective” range (3–12 cm H2O). The control group received standard-of-care.
MEASUREMENTS AND MAIN RESULTS:
Transdiaphragmatic pressure, transpulmonary pressure, and tidal volume were monitored continuously for 24 hours in both groups. In the intervention group, more breaths were within “diaphragm-protective” range compared with the control group (median 81%; interquartile range [64–86%] vs 35% [16–60%], respectively; p < 0.001). Dynamic transpulmonary pressures (20.5 ± 7.1 vs 18.5 ± 7.0 cm H2O; p = 0.321) and tidal volumes (7.56 ± 1.47 vs 7.54 ± 1.22 mL/kg; p = 0.961) were not different in the intervention and control group, respectively.
CONCLUSIONS:
Titration of inspiratory support based on patient breathing effort greatly increased the time that patients had diaphragm effort in the predefined “diaphragm-protective” range without compromising tidal volumes and transpulmonary pressures. This study provides a strong rationale for further studies powered on patient-centered outcomes. |
| first_indexed | 2024-03-07T07:26:28Z |
| format | Journal article |
| id | oxford-uuid:eb07f98b-444b-41cf-b5de-650284bb006d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:26:28Z |
| publishDate | 2022 |
| publisher | Lippincott, Williams and Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:eb07f98b-444b-41cf-b5de-650284bb006d2022-11-22T06:24:50ZLung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:eb07f98b-444b-41cf-b5de-650284bb006dEnglishSymplectic ElementsLippincott, Williams and Wilkins2022de Vries, HJJonkman, AHde Grooth, HJDuitman, JWGirbes, ARJOttenheijm, CACSchultz, MJvan de Ven, PMZhang, Yde Man, AMETuinman, PRHeunks, LMAOBJECTIVES: Lung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes diaphragm atrophy, whereas excessive breathing effort induces diaphragm and lung injury. In a proof-of-concept study, we aimed to assess whether titration of inspiratory support based on diaphragm effort increases the time that patients have effort in a predefined “diaphragm-protective” range, without compromising lung-protective ventilation. DESIGN: Randomized clinical trial. SETTING: Mixed medical-surgical ICU in a tertiary academic hospital in the Netherlands. PATIENTS: Patients (n = 40) with respiratory failure ventilated in a partially-supported mode. INTERVENTIONS: In the intervention group, inspiratory support was titrated hourly to obtain transdiaphragmatic pressure swings in the predefined “diaphragm-protective” range (3–12 cm H2O). The control group received standard-of-care. MEASUREMENTS AND MAIN RESULTS: Transdiaphragmatic pressure, transpulmonary pressure, and tidal volume were monitored continuously for 24 hours in both groups. In the intervention group, more breaths were within “diaphragm-protective” range compared with the control group (median 81%; interquartile range [64–86%] vs 35% [16–60%], respectively; p < 0.001). Dynamic transpulmonary pressures (20.5 ± 7.1 vs 18.5 ± 7.0 cm H2O; p = 0.321) and tidal volumes (7.56 ± 1.47 vs 7.54 ± 1.22 mL/kg; p = 0.961) were not different in the intervention and control group, respectively. CONCLUSIONS: Titration of inspiratory support based on patient breathing effort greatly increased the time that patients had diaphragm effort in the predefined “diaphragm-protective” range without compromising tidal volumes and transpulmonary pressures. This study provides a strong rationale for further studies powered on patient-centered outcomes. |
| spellingShingle | de Vries, HJ Jonkman, AH de Grooth, HJ Duitman, JW Girbes, ARJ Ottenheijm, CAC Schultz, MJ van de Ven, PM Zhang, Y de Man, AME Tuinman, PR Heunks, LMA Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title | Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title_full | Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title_fullStr | Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title_full_unstemmed | Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title_short | Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial |
| title_sort | lung and diaphragm protective ventilation by titrating inspiratory support to diaphragm effort a randomized clinical trial |
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