Cecília R. Buratti, Cinara Andreolio, Francisco Bruno, Lívia B. Andrade, Mônica Marcon, Nádia F. Navarro, Jefferson P. Piva, Philippe Jouvet
{"title":"Peak inspiratory pressure lacks accuracy to estimate plateau pressure in infants with severe obstructive lower airway disease","authors":"Cecília R. Buratti, Cinara Andreolio, Francisco Bruno, Lívia B. Andrade, Mônica Marcon, Nádia F. Navarro, Jefferson P. Piva, Philippe Jouvet","doi":"10.1002/ppul.27245","DOIUrl":null,"url":null,"abstract":"PurposeIn children with acute respiratory distress syndrome receiving mechanical ventilation, the peak inspiratory pressure (PIP) is close to plateau pressure (P<jats:sub>PLAT</jats:sub>) when inspiratory flow approaches zero. We aimed to evaluate the reliability of PIP to estimate P<jats:sub>PLAT</jats:sub> in infants with severe respiratory viral infection (SRVI), characterized by increased airway resistance, and the accuracy of an equational model to estimates P<jats:sub>PLAT</jats:sub> (eP<jats:sub>PLAT</jats:sub>) based on PIP.MethodsThis was a retrospective observational study including mechanically ventilated children (1 to 24 month old) with SRVI, whose respiratory mechanics measurements were performed to evaluate PIP and P<jats:sub>PLAT.</jats:sub> The measured P<jats:sub>PLAT</jats:sub> was compared with the result of the equation: eP<jats:sub>PLAT</jats:sub> = PIP – [5.067 – (0.858 × static compliance) – (0.018 × inspiratory resistance) – (0.390 × pressure above positive‐end expiratory pressure) + (4.989 × inspiratory time)].ResultsThirty‐seven patients were included, with a median age of 3 (2–5) months. They presented a high inspiratory and expiratory resistance (136 ± 43 and 168 ± 66 cmH<jats:sub>2</jats:sub>O/L/s, respectively) and a moderate reduction in static compliance: 0.75 ± 0.3 mL/kg/cmH<jats:sub>2</jats:sub>O. PIP overestimated P<jats:sub>PLAT</jats:sub> (33 ± 3 and 26 ± 5 cmH<jats:sub>2</jats:sub>O, <jats:italic>p</jats:italic> = 0.01), with a mean difference of 7.3 ± 4 cmH<jats:sub>2</jats:sub>O. Moreover, the Bland‐Altman analysis demonstrated a mean difference between P<jats:sub>PLAT</jats:sub> and eP<jats:sub>PLAT</jats:sub> of 1.0 ± 4.0 cmH<jats:sub>2</jats:sub>O, with 95% limits of agreement of –6.9 and 8.8.ConclusionsA significant difference between PIP and P<jats:sub>PLAT</jats:sub> was observed in infants with SRVI. The equation model was inaccurate for estimating P<jats:sub>PLAT</jats:sub> based on PIP. Any estimation of P<jats:sub>PLAT</jats:sub> from PIP needs to consider the resistance component of the respiratory system.","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Pulmonology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ppul.27245","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
PurposeIn children with acute respiratory distress syndrome receiving mechanical ventilation, the peak inspiratory pressure (PIP) is close to plateau pressure (PPLAT) when inspiratory flow approaches zero. We aimed to evaluate the reliability of PIP to estimate PPLAT in infants with severe respiratory viral infection (SRVI), characterized by increased airway resistance, and the accuracy of an equational model to estimates PPLAT (ePPLAT) based on PIP.MethodsThis was a retrospective observational study including mechanically ventilated children (1 to 24 month old) with SRVI, whose respiratory mechanics measurements were performed to evaluate PIP and PPLAT. The measured PPLAT was compared with the result of the equation: ePPLAT = PIP – [5.067 – (0.858 × static compliance) – (0.018 × inspiratory resistance) – (0.390 × pressure above positive‐end expiratory pressure) + (4.989 × inspiratory time)].ResultsThirty‐seven patients were included, with a median age of 3 (2–5) months. They presented a high inspiratory and expiratory resistance (136 ± 43 and 168 ± 66 cmH2O/L/s, respectively) and a moderate reduction in static compliance: 0.75 ± 0.3 mL/kg/cmH2O. PIP overestimated PPLAT (33 ± 3 and 26 ± 5 cmH2O, p = 0.01), with a mean difference of 7.3 ± 4 cmH2O. Moreover, the Bland‐Altman analysis demonstrated a mean difference between PPLAT and ePPLAT of 1.0 ± 4.0 cmH2O, with 95% limits of agreement of –6.9 and 8.8.ConclusionsA significant difference between PIP and PPLAT was observed in infants with SRVI. The equation model was inaccurate for estimating PPLAT based on PIP. Any estimation of PPLAT from PIP needs to consider the resistance component of the respiratory system.
期刊介绍:
Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases.
PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.