Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study
Background Although patients with interstitial pneumonia pattern (ILD-UIP) and acute exacerbation (AE) leading to severe acute respiratory failure may require invasive mechanical ventilation (MV), physiological data on lung mechanics during MV are lacking. We aimed at describing the physiological effect of lung-protective ventilation in patients with AE-ILD-UIP compared with primary ARDS. Methods Partitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and $ PaO_{2} $/$ FiO_{2} $ ratio). Three PEEP levels (zero = ZEEP, 4–8 $ cmH_{2} $O = PEEPLOW, and titrated to achieve positive end-expiratory transpulmonary pressure PL,EE = PEEPTITRATED) were used for measurements. Results Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median PL,EE at ZEEP was − 4.3 [− 7.6– − 2.3] $ cmH_{2} $O and lung elastance (EL) 44 [40–51] $ cmH_{2} $O/L. At $ PEEP_{LOW} $, PL,EE remained negative and EL did not change (p = 0.995) versus ZEEP. At $ PEEP_{TITRATED} $, PL,EE increased to 0.8 [0.3–1.5] $ cmH_{2} $O and EL to 49 [43–59] (p = 0.004 and p < 0.001 compared to ZEEP and $ PEEP_{LOW} $, respectively). ΔPL decreased at $ PEEP_{LOW} $ (p = 0.018) and increased at $ PEEP_{TITRATED} $ (p = 0.003). In matched ARDS control PEEP titration to obtain a positive PL,EE did not result in significant changes in EL and ΔPL. Conclusions In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Critical care - 27(2023), 1 vom: 18. Okt. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tonelli, Roberto [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Anmerkungen: |
© The Author(s) 2023 |
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| doi: |
10.1186/s13054-023-04682-5 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
SPR053451481 |
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| 041 | |a eng | ||
| 100 | 1 | |a Tonelli, Roberto |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study |
| 264 | 1 | |c 2023 | |
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| 520 | |a Background Although patients with interstitial pneumonia pattern (ILD-UIP) and acute exacerbation (AE) leading to severe acute respiratory failure may require invasive mechanical ventilation (MV), physiological data on lung mechanics during MV are lacking. We aimed at describing the physiological effect of lung-protective ventilation in patients with AE-ILD-UIP compared with primary ARDS. Methods Partitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and $ PaO_{2} $/$ FiO_{2} $ ratio). Three PEEP levels (zero = ZEEP, 4–8 $ cmH_{2} $O = PEEPLOW, and titrated to achieve positive end-expiratory transpulmonary pressure PL,EE = PEEPTITRATED) were used for measurements. Results Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median PL,EE at ZEEP was − 4.3 [− 7.6– − 2.3] $ cmH_{2} $O and lung elastance (EL) 44 [40–51] $ cmH_{2} $O/L. At $ PEEP_{LOW} $, PL,EE remained negative and EL did not change (p = 0.995) versus ZEEP. At $ PEEP_{TITRATED} $, PL,EE increased to 0.8 [0.3–1.5] $ cmH_{2} $O and EL to 49 [43–59] (p = 0.004 and p < 0.001 compared to ZEEP and $ PEEP_{LOW} $, respectively). ΔPL decreased at $ PEEP_{LOW} $ (p = 0.018) and increased at $ PEEP_{TITRATED} $ (p = 0.003). In matched ARDS control PEEP titration to obtain a positive PL,EE did not result in significant changes in EL and ΔPL. Conclusions In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics. | ||
| 650 | 4 | |a Interstitial lung disease |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Pulmonary fibrosis |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Usual interstitial pneumonia |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Acute respiratory failure |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a ARDS |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Lung elastance |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Lung elastance |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Respiratory mechanics |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a End-inspiratory transpulmonary pressure |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a End-expiratory transpulmonary pressure |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Invasive mechanical ventilation, VILI |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Transpulmonary pressure |7 (dpeaa)DE-He213 | |
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| 700 | 1 | |a Ball, Lorenzo |4 aut | |
| 700 | 1 | |a Castaniere, Ivana |4 aut | |
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| 700 | 1 | |a Grasselli, Giacomo |4 aut | |
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| 700 | 1 | |a Marchioni, Alessandro |4 aut | |
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