6533b7d8fe1ef96bd1269927
RESEARCH PRODUCT
Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.
Roberto TonelliAndrea CortegianiAlessandro MarchioniRiccardo FantiniLuca TabbìIvana CastaniereEmanuela BiagioniStefano BusaniChiara NaniCaterina CerboneMorgana VermiFilippo GozziGiulia BruzziLinda ManicardiMaria Rosaria PellegrinoBianca BeghèMassimo GirardisPaolo PelosiCesare GregorettiLorenzo BallClini Enrico Msubject
Self-inflicted lung injuryCritical Care and Intensive Care MedicineAcute respiratory failureself-inflicted lung injuryNon-invasive Mechanical ventilationesophageal pressure swingsacute respiratory failure non-invasive mechanical ventilation esophageal pressure swings nasal pressure swings endotracheal intubation COVID-19 respiratory monitoring inspiratory effort self-inflicted lung injuryHumansInspiratory effortendotracheal intubationEsophageal pressure swingsAcute respiratory failure Non-invasive Mechanical ventilation Esophageal pressure swings Nasal pressure swings Endotracheal intubation COVID-19 Respiratory monitoring Inspiratory effort Self-inflicted lung injuryRespiratory Distress Syndromeacute respiratory failurenon-invasive mechanical ventilationNoninvasive VentilationRespiratory monitoringCOVID-19Endotracheal intubationRespiration ArtificialAcute respiratory failure; COVID-19; Endotracheal intubation; Esophageal pressure swings; Inspiratory effort; Nasal pressure swings; Non-invasive Mechanical ventilation; Respiratory monitoring; Self-inflicted lung injuryNasal pressure swingsnasal pressure swingsrespiratory monitoringRespiratory Insufficiencyinspiratory effortdescription
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 (ΔPes) and nasal (ΔPnos) 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 ΔPes and ΔPnos served as primary outcome. The effect of ΔPnos measurements on respiratory rate and ΔPes was also assessed. Results ΔPes and ΔPnos were strongly correlated at admission (R2 = 0.88, p < 0.001) and 24 h apart (R2 = 0.94, p < 0.001). The nasal plug insertion and the mouth closure required for ΔPnos measurement did not result in significant change of respiratory rate and ΔPes. 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 [R2 = 0.79, p < 0.001] or non-invasive ventilation [R2 = 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. ΔPnos might warrant further investigation as a measure of inspiratory effort in patients with ARF. Trial registration: NCT03826797. Registered October 2016.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2022-01-01 | Critical care (London, England) |