Energy transmission in mechanically ventilated children: a translational study

Critical Care

Johannes G. M. Burgerhof¹  Alette A. Koopman²  Patrick van Schelven²  Robert G. T. Blokpoel²  Jefta van Dijk²  Martin C. J. Kneyber³  Stavroula Ilia⁴  Dick G. Markhorst⁵ 

[1] Department of Epidemiology, University Medical Center Groningen, The University of Groningen, Groningen, the Netherlands;Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, The University of Groningen, P.O. Box 30.001, Internal Postal Code CA 80, 9700, Groningen, RB, the Netherlands;Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, The University of Groningen, P.O. Box 30.001, Internal Postal Code CA 80, 9700, Groningen, RB, the Netherlands;Critical Care, Anesthesia, Peri-operative Medicine & Emergency Medicine (CAPE), The University of Groningen, Groningen, the Netherlands;Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, The University of Groningen, P.O. Box 30.001, Internal Postal Code CA 80, 9700, Groningen, RB, the Netherlands;Pediatric Intensive Care Unit, University Hospital Heraklion, University of Crete, Crete, Greece;Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, the Netherlands;

关键词: Mechanical power;    Energy per breath;    Mechanical ventilation;    Pediatric;    Ventilator-induced lung injury (VILI);   

DOI  :  10.1186/s13054-020-03313-7

来源: Springer

【 摘 要 】

BackgroundRecurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how ME relates to underlying lung pathology and outcome in mechanically ventilated children. We therefore tested the hypothesis that ME per breath with tidal volume (Vt) normalized to bodyweight correlates with underlying lung pathology and to study the effect of resistance on the ME dissipated to the lung.MethodsWe analyzed routinely collected demographic, physiological, and laboratory data from deeply sedated and/or paralyzed children < 18 years with and without lung injury. Patients were stratified into respiratory system mechanic subgroups according to the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) definition. The association between MP, ME, lung pathology, and duration of mechanical ventilation as a primary outcome measure was analyzed adjusting for confounding variables and effect modifiers. The effect of endotracheal tube diameter (ETT) and airway resistance on energy dissipation to the lung was analyzed in a bench model with different lung compliance settings.ResultsData of 312 patients with a median age of 7.8 (1.7–44.2) months was analyzed. Age (p <  0.001), RR p <  0.001), and Vt <  0.001) were independently associated with MPrs. ME but not MP correlated significantly (p <  0.001) better with lung pathology. Competing risk regression analysis adjusting for PRISM III 24 h score and PEMVECC stratification showed that ME on day 1 or day 2 of MV but not MP was independently associated with the duration of mechanical ventilation. About 33% of all energy generated by the ventilator was transferred to the lung and highly dependent on lung compliance and airway resistance but not on endotracheal tube size (ETT) during pressure control (PC) ventilation.ConclusionsME better related to underlying lung pathology and patient outcome than MP. The delivery of generated energy to the lung was not dependent on ETT size during PC ventilation. Further studies are needed to identify injurious MErs thresholds in ventilated children.

【 授权许可】

CC BY