Abstract
Background: The optimal level of positive end-expiratory pressure is still under debate. There are scare data examining the association of PEEP with transpulmonary pressure (TPP), end-expiratory lung volume (EELV) and intraabdominal pressure in ventilated patients with and without ARDS. Methods: We analyzed lung mechanics in 3 patient groups: group A, patients with ARDS; group B, obese patients (body mass index (BMI) > 30 kg/m2) and group C, a control group. Three levels of PEEP (5, 10, 15 cm H2O) were used to investigate the consequences for lung mechanics. Results: Fifty patients were included, 22 in group A, 18 in group B (BMI 38 ± 2 kg/m2) and 10 in group C. At baseline, oxygenation showed no differences between the groups. Driving pressure (ΔP) and transpulmonary pressure (ΔPL) was higher in group B than in groups A and C at a PEEP of 5 cm H2O (ΔP A: 15 ± 1, B: 18 ± 1, C: 14 ± 1 cm H2O; ΔPL A: 10 ± 1, B: 13 ± 1, C: 9 ± 0 cm H2O). Peak inspiratory pressure (Pinsp) rose in all groups as PEEP increased, but the resulting driving pressure and transpulmonary pressure were reduced, whereas EELV increased. Conclusion: Measuring EELV or TPP allows a personalized approach to lung-protective ventilation.
Highlights
The optimal level of positive end-expiratory pressure is still under debate
We hypothesized that an advanced measurement of end-expiratory lung volume (EELV), transpulmonary pressure (TPP) and intra-abdominal pressure (IAP) would allow an individualized titration of mechanical ventilation
After completion of the measurement program at a positive end-expiratory pressure (PEEP) of 15 cm H2O, PEEP was reduced to 10 cm H2O, and inspiratory pressure was maintained to keep the tidal volume at 6 mL/kg pbw
Summary
One of the most frequently applied strategies in the intensive care unit is often lifesaving. Causes of VILI are mainly stress, transpulmonary pressure (TPP) and strain and applied tidal volume (VT) in relation to end-expiratory lung volume (EELV) [2]. These two elements are not routinely measured at the bedside in patients with acute respiratory distress (ARDS) [3]. 50% of the intra-abdominal pressure (IAP) is transmitted to the intrathoracic compartment [11] It has a direct impact on EELV and TPP. The relationship between transpulmonary pressure, lung volume and IAP in different types of patients with mechanical ventilation has not yet been fully explored. We hypothesized that an advanced measurement of EELV, TPP and IAP would allow an individualized titration of mechanical ventilation
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