Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure

Critical Care

Lorenzo Ball¹  Paolo Pelosi¹  Cesare Gregoretti²  Andrea Cortegiani²  Massimo Girardis³  Stefano Busani³  Emanuela Biagioni³  Filippo Gozzi⁴  Riccardo Fantini⁴  Bianca Beghè⁴  Luca Tabbì⁴  Chiara Nani⁴  Alessandro Marchioni⁴  Ivana Castaniere⁴  Giulia Bruzzi⁴  Caterina Cerbone⁴  Linda Manicardi⁴  Maria Rosaria Pellegrino⁴  Enrico Clini⁴  Roberto Tonelli⁴  Morgana Vermi⁴ 

[1] Department of Surgical Sciences and Integrated Diagnostics, University of Genoa;Department of Surgical, Oncological and Oral Science (DiChirOnS), University of Palermo;Intensive Care Unit, University Hospital of Modena, University of Modena Reggio Emilia;Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia;

关键词: Acute respiratory failure;    Non-invasive Mechanical ventilation;    Esophageal pressure swings;    Nasal pressure swings;    Endotracheal intubation;    COVID-19;   

DOI  :  10.1186/s13054-022-03938-w

来源: DOAJ

【 摘 要 】

Abstract Background Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔP es) and nasal (ΔP nos) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF. Methods From January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of non-invasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 h after starting NRS. Correlation between ΔP es and ΔP nos served as primary outcome. The effect of ΔP nos measurements on respiratory rate and ΔP es was also assessed. Results ΔP es and ΔP nos were strongly correlated at admission (R 2 = 0.88, p < 0.001) and 24 h apart (R 2 = 0.94, p < 0.001). The nasal plug insertion and the mouth closure required for ΔP nos measurement did not result in significant change of respiratory rate and ΔP es. The correlation between measures at 24 h remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R 2 = 0.79, p < 0.001] or non-invasive ventilation [R 2 = 0.95, p < 0.001]). Conclusions In a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. ΔP nos might warrant further investigation as a measure of inspiratory effort in patients with ARF. Trial registration: NCT03826797 . Registered October 2016.

【 授权许可】

Unknown