Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract Background Dynamic pulmonary hyperinflation may develop in patients with chronic obstructive pulmonary disease (COPD) due to dynamic airway collapse and/or increased airway resistance, increasing the risk of volutrauma and hemodynamic compromise. The reference standard to quantify dynamic p...

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Autores principales:	L. H. Roesthuis, J. G. van der Hoeven, C. Guérin, J. Doorduin, L. M. A. Heunks
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Chronic obstructive pulmonary disease Dynamic pulmonary hyperinflation Mechanical ventilation Volume at end-inspiration Bedside techniques Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/83489668ad8847dc90890f038f92e944
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spelling	oai:doaj.org-article:83489668ad8847dc90890f038f92e9442021-12-05T12:03:47ZThree bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease10.1186/s13613-021-00948-92110-5820https://doaj.org/article/83489668ad8847dc90890f038f92e9442021-12-01T00:00:00Zhttps://doi.org/10.1186/s13613-021-00948-9https://doaj.org/toc/2110-5820Abstract Background Dynamic pulmonary hyperinflation may develop in patients with chronic obstructive pulmonary disease (COPD) due to dynamic airway collapse and/or increased airway resistance, increasing the risk of volutrauma and hemodynamic compromise. The reference standard to quantify dynamic pulmonary hyperinflation is the measurement of the volume at end-inspiration (Vei). As this is cumbersome, the aim of this study was to evaluate if methods that are easier to perform at the bedside can accurately reflect Vei. Methods Vei was assessed in COPD patients under controlled protective mechanical ventilation (7 ± mL/kg) on zero end-expiratory pressure, using three techniques in a fixed order: (1) reference standard (Veireference): passive exhalation to atmosphere from end-inspiration in a calibrated glass burette; (2) ventilator maneuver (Veimaneuver): measuring the expired volume during a passive exhalation of 45s using the ventilator flow sensor; (3) formula (Veiformula): (Vt × P plateau)/(P plateau − PEEPi), with Vt tidal volume, P plateau is plateau pressure after an end-inspiratory occlusion, and PEEPi is intrinsic positive end-expiratory pressure after an end-expiratory occlusion. A convenience sample of 17 patients was recruited. Results Veireference was 1030 ± 380 mL and had no significant correlation with P plateau (r 2 = 0.06; P = 0.3710) or PEEPi (r 2 = 0.11; P = 0.2156), and was inversely related with P drive (calculated as P plateau −PEEPi) (r 2 = 0.49; P = 0.0024). A low bias but rather wide limits of agreement and fairly good correlations were found when comparing Veimaneuver and Veiformula to Veireference. Vei remained stable during the study period (low bias 15 mL with high agreement (95% limits of agreement from − 100 to 130 mL) and high correlation (r 2 = 0.98; P < 0.0001) between both measurements of Veireference). Conclusions In patients with COPD, airway pressures are not a valid representation of Vei. The three techniques to quantify Vei show low bias, but wide limits of agreement.L. H. RoesthuisJ. G. van der HoevenC. GuérinJ. DoorduinL. M. A. HeunksSpringerOpenarticleChronic obstructive pulmonary diseaseDynamic pulmonary hyperinflationMechanical ventilationVolume at end-inspirationBedside techniquesMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAnnals of Intensive Care, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Chronic obstructive pulmonary disease Dynamic pulmonary hyperinflation Mechanical ventilation Volume at end-inspiration Bedside techniques Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Chronic obstructive pulmonary disease Dynamic pulmonary hyperinflation Mechanical ventilation Volume at end-inspiration Bedside techniques Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 L. H. Roesthuis J. G. van der Hoeven C. Guérin J. Doorduin L. M. A. Heunks Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
description	Abstract Background Dynamic pulmonary hyperinflation may develop in patients with chronic obstructive pulmonary disease (COPD) due to dynamic airway collapse and/or increased airway resistance, increasing the risk of volutrauma and hemodynamic compromise. The reference standard to quantify dynamic pulmonary hyperinflation is the measurement of the volume at end-inspiration (Vei). As this is cumbersome, the aim of this study was to evaluate if methods that are easier to perform at the bedside can accurately reflect Vei. Methods Vei was assessed in COPD patients under controlled protective mechanical ventilation (7 ± mL/kg) on zero end-expiratory pressure, using three techniques in a fixed order: (1) reference standard (Veireference): passive exhalation to atmosphere from end-inspiration in a calibrated glass burette; (2) ventilator maneuver (Veimaneuver): measuring the expired volume during a passive exhalation of 45s using the ventilator flow sensor; (3) formula (Veiformula): (Vt × P plateau)/(P plateau − PEEPi), with Vt tidal volume, P plateau is plateau pressure after an end-inspiratory occlusion, and PEEPi is intrinsic positive end-expiratory pressure after an end-expiratory occlusion. A convenience sample of 17 patients was recruited. Results Veireference was 1030 ± 380 mL and had no significant correlation with P plateau (r 2 = 0.06; P = 0.3710) or PEEPi (r 2 = 0.11; P = 0.2156), and was inversely related with P drive (calculated as P plateau −PEEPi) (r 2 = 0.49; P = 0.0024). A low bias but rather wide limits of agreement and fairly good correlations were found when comparing Veimaneuver and Veiformula to Veireference. Vei remained stable during the study period (low bias 15 mL with high agreement (95% limits of agreement from − 100 to 130 mL) and high correlation (r 2 = 0.98; P < 0.0001) between both measurements of Veireference). Conclusions In patients with COPD, airway pressures are not a valid representation of Vei. The three techniques to quantify Vei show low bias, but wide limits of agreement.
format	article
author	L. H. Roesthuis J. G. van der Hoeven C. Guérin J. Doorduin L. M. A. Heunks
author_facet	L. H. Roesthuis J. G. van der Hoeven C. Guérin J. Doorduin L. M. A. Heunks
author_sort	L. H. Roesthuis
title	Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
title_short	Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
title_full	Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
title_fullStr	Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
title_full_unstemmed	Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
title_sort	three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/83489668ad8847dc90890f038f92e944
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Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease

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