Respiratory care最新文献

{"title":"Mechanical Power to Predict Ventilator Liberation in Patients With a Tracheostomy.","authors":"Toshiharu Nakama, Takehiro Umemura, Soukun Hoshino, Masahiro Tamashiro, Kenichi Satoh, Hiroshi Sekiguchi","doi":"10.1089/respcare.12237","DOIUrl":"https://doi.org/10.1089/respcare.12237","url":null,"abstract":"<p><p><b>Background:</b> Mechanical power (MP) is useful for predicting the outcomes of attempts to liberate patients from mechanical ventilation. MP is computed based on measured variables derived to determine the power in joules required to breathe while receiving mechanical ventilation. The main objectives of this study were to calculate a cutoff value of MP that would predict successful liberation and to determine the prediction rate of liberation success based on this cutoff value. <b>Methods:</b> This was a single-center retrospective study. Data from 110 tracheostomized subjects receiving mechanical ventilation were analyzed. We divided subjects into two groups based on ventilator liberation outcome. Confounding factors in subject background were adjusted using propensity score matching (PSM). Statistically significant differences in MP at tracheostomy and liberation success between liberation success and failure groups were examined. We calculated the MP cutoff value for successful liberation using the area under the curve of the receiver operating characteristic (ROC) and its corresponding prediction rate of liberation success. <b>Results:</b> The number of subjects in the successful liberation group was 79 and that of the failed liberation group was 31. The MP cutoff value and corresponding prediction rate for liberation success were 256.5 J/min (area under the curve-ROC = 0.839) and 92.2%, respectively. After PSM, the low MP group (<i>n =</i> 36), divided based on the MP cutoff value, had a significantly higher liberation success rate than the high MP group (<i>n =</i> 36), with an odds ratio of 19.95 (CI 3.95, 91.23, <i>P</i> < .001). <b>Conclusion:</b> MP at tracheostomy was a strong predictor of successful ventilator liberation, and the prediction rate of liberation success based on the MP cutoff value was shown to be very high. We recommend that patients with low MP be actively considered for liberation. In contrast, those with high MP should continue weaning while simultaneously making early transfer arrangements if liberation is unsuccessful.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Comparison of Oximetry Devices During 6-Minute Walk Tests.","authors":"Emma M Marshall, Angeline Filiex, Max Schulte, Karla M Logie, Julian Gin, Mark Horrigan, Leona Dowman, Thomas J Churchward, Yet H Khor","doi":"10.1089/respcare.12259","DOIUrl":"https://doi.org/10.1089/respcare.12259","url":null,"abstract":"<p><p><b>Background:</b> Pulse oximetry is a common technique used to measure S_pO₂, with increasing numbers of portable devices of different designs and technical specifications. This study examined accuracy of commercial and medical-grade portable oximetry devices (BioBeat wristwatch, Nonin WristOx₂ 3150, and Heart Sure A320) in measuring S_pO₂ compared with the reference standard (Masimo Rad-5) during 6-min walk tests (6MWTs). <b>Methods:</b> This prospective study included 50 subjects, with 10 recruited for each of the five target groups, including COPD, interstitial lung disease, pulmonary hypertension, oxygen therapy users, and other cardiac/respiratory diseases. All subjects underwent 6MWT using the reference standard and the three test oximetry devices. Accuracy was measured by comparing mean nadir S_pO₂. Subjects were asked to rate their preference for different oximetry devices at test completion. <b>Results:</b> In contrast to the Masimo, the Nonin had lower nadir and mean S_pO₂ <i>(P</i> ≤ .001 for both), with higher measurements for the BioBeat (<i>P</i> < .001 for both) and no differences for the Heart Sure (<i>P</i> = .18 for nadir S_pO₂, <i>P</i> <b>=</b> .96 for mean S_pO₂). Time spent at S_pO₂ ≤ 88 was higher for the Nonin (70%, <i>P</i> < .001) but lower for the Heart Sure (58%, <i>P</i> < .001), compared with the Masimo (64%). There were no significant differences observed in peak heart rate measurements between the Masimo with the Nonin and BioBeat (<i>P</i> < .05 for both), with lower measurements using the Heart Sure (<i>P</i> < .001). The BioBeat was most preferable amongst subjects (<i>n =</i> 31), with all test oximeters having high patient satisfaction (mean 7-point Likert scale scores of 6-7). <b>Conclusion:</b> The Heart Sure A320 and Nonin Wrist-Ox₂ 3150 had comparable performance in detecting nadir S_pO₂ within a mean difference of 3% in comparison with the Masimo Rad-5, with potential use for remote monitoring.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Exercise Capacity After Physical Training in Individuals With COPD and Different Body Composition Phenotypes.","authors":"Isabella Ortiz Garcia, Kouji Kakazu, Juliana Thais Alves Lopes, Letícia Medeiros, Karina Couto Furlanetto, Fabio Pitta","doi":"10.1089/respcare.12695","DOIUrl":"https://doi.org/10.1089/respcare.12695","url":null,"abstract":"<p><p><b>Background:</b> Individuals with COPD may present extra-pulmonary features such as body composition abnormalities. These patients benefit from exercise training, especially in improving their exercise capacity. However, it is unknown whether the magnitude of improvement in exercise capacity is equally proportional in the different body composition phenotypes. We sought to investigate whether individuals with COPD classified in different body composition phenotypes present differences in the magnitude of improvement of exercise capacity after an exercise training program. <b>Methods:</b> Individuals with COPD were assessed before and after a 3-month high intensity exercise training program regarding their body composition (electrical bioimpedance) and functional exercise capacity (6-min walk test [6MWT]). The individuals were classified in four phenotypes of body composition: normal, sarcopenic, obese, and obese-sarcopenic. <b>Results:</b> Fifty-one subjects (26 men, 66 ± 8 years, body mass index 27 ± 6 kg/m²; FEV₁ 50 [34-64] %predicted) were assessed. After the training program there was significant interaction among body composition phenotypes and variation of fat mass <i>(P</i> = .05) and its respective index <i>(P</i> = .05). There was no interaction between improvement in the 6MWT and the body composition phenotypes; however, sarcopenic and obese-sarcopenic individuals improved significantly their 6MWT, both in distance (30 ± 50 m and 46 ± 48 m, respectively) and in %predicted (4 ± 10 and 7 ± 9, respectively), which did not occur in the two other phenotypes. <b>Conclusions:</b> There was interaction of body composition phenotype and variation of fat mass after exercise training. However, the presence of sarcopenia (associated or not with obesity) indicated significant and clinically relevant improvements in the 6MWT.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Telemonitoring With Exacerbation Prediction Algorithm Versus Telemonitoring Alone on Hospitalizations and Health-Related Quality of Life in Patients With COPD.","authors":"Thomas Kronborg, Stine Hangaard, Sisse Heiden Laursen, Lisa Korsbakke Emtekær Hæsum, Julie Egmose, Clara Bender, Pernille Heyckendorff Secher, Ole Hejlesen, Flemming Witt Udsen","doi":"10.1089/respcare.12611","DOIUrl":"https://doi.org/10.1089/respcare.12611","url":null,"abstract":"<p><p><b>Background:</b> Unreported and untreated exacerbations of COPD have significant negative impacts on health status, disease progression, rate of hospitalization, and readmission. The present study investigated whether a COPD exacerbation prediction algorithm embedded into a telemonitoring system can reduce the number of hospitalizations and improve health-related quality of life (HRQOL) compared with telemonitoring alone. <b>Methods:</b> A total of 137 participants were enrolled in this single-blinded randomized controlled trial. Patients were eligible for inclusion if they had a COPD diagnosis, were adults, had fixed residence in Aalborg Municipality in Denmark, and already used an existing telemonitoring system. The primary outcome was the between-group difference in the number of acute hospitalizations per subject after 6 months of follow-up. Secondary outcomes included the difference in all-cause hospitalization, HRQOL measured by 12-item Short Form Health Survey (version 2) and EuroQol-5 Dimension Questionnaire (EQ-5D-5L), and mortality after 6 months. Data were analyzed according to the intention-to-treat principle. <b>Results:</b> The adjusted incidence rate ratio (IRR) of acute hospitalizations per subject was 1.30 (95% CI 0.50-3.38). The odds ratio (OR) for the hospitalization proportion was 2.10 (95% CI: 0.72-6.09). The adjusted IRR for the number of all-cause hospitalizations were 1.25 (95% CI: 0.51-3.07), whereas the OR for an all-cause hospitalization proportion was 1.92 (95% CI: 0.70-5.26). The adjusted OR for mortality was 0.46 (95% CI: 0.11-1.94). The adjusted mean difference in the physical component score and mental component score was 0.77 (95% CI: -1.72 to 3.47) and 0.91 (95% CI: -2.63 to 4.72), respectively, and -0.05 (95% CI: -0.14 to 0.03) for the EQ-5D index score. All results were nonstatistically significant. <b>Conclusions:</b> No definitive conclusions could be drawn regarding the effect on hospitalizations and HRQOL when implementing a COPD prediction algorithm in addition to telemonitoring.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence for the Detection of Patient-Ventilator Asynchrony.","authors":"Abdulhakim Tlimat, Cosmo Fowler, Sami Safadi, Robert B Johnson, Sandeep Bodduluri, Peter Morris, Surya P Bhatt","doi":"10.1089/respcare.12540","DOIUrl":"https://doi.org/10.1089/respcare.12540","url":null,"abstract":"<p><p>Patient-ventilator asynchrony (PVA) is a challenge to invasive mechanical ventilation characterized by misalignment of ventilatory support and patient respiratory effort. PVA is highly prevalent and associated with adverse clinical outcomes, including increased work of breathing, oxygen consumption, and risk of barotrauma. Artificial intelligence (AI) is a potentially transformative solution offering capabilities for automated detection of PVA. This narrative review characterizes the landscape of AI models designed for PVA detection and quantification. A comprehensive literature search identified 13 studies, spanning diverse settings and patient populations. Machine learning (ML) techniques, derivation datasets, types of asynchronies detected, and performance metrics were assessed to provide a contemporary view of AI in this domain. We reviewed 166 articles published between 1989 and April 2024, of which 13 were included, encompassing 332 participants and analyzing >5.8 million breaths. Patient counts ranged between 8 and 107 and breath data ranged between 1,375 and 4.2 M. The reason for invasive mechanical ventilation use was given as ARDS in three articles, whereas the remainder had different invasive mechanical ventilation indications. Various ML methods as well as newer deep learning techniques were used to address PVA types. Sensitivity and specificity of 10 of the 13 models were >0.9, and 8 models reported accuracy of >0.9. AI models have significant potential to address PVA in invasive mechanical ventilation, displaying high accuracy across various populations and asynchrony types. This showcases their potential to accurately detect and quantify PVA. Future work should focus on model validation in diverse clinical settings and patient populations.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Dilemma of Water-Filled Tracheostomy Tube Cuffs.","authors":"Bryan D Kraft, Elisa Goodman, Dawn Sitler, Tiffany Fordson, Charlotte Gibson, Nizama Samih, Himanshu Kumawat, Palmer Wade, Marin H Kollef","doi":"10.1089/respcare.12707","DOIUrl":"https://doi.org/10.1089/respcare.12707","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rebound Hypoxemia in Mechanically Ventilated Patients With COVID-19 Completing a Standard 10-Day Course of Corticosteroid Therapy.","authors":"Rahul Costa-Pinto, Hannah Rotherham, Zachary O'Brien, Padeepa Perera, Vicky Chen, Christopher Massarany, Brett Xu, Rinaldo Bellomo","doi":"10.1089/respcare.12494","DOIUrl":"https://doi.org/10.1089/respcare.12494","url":null,"abstract":"<p><p><b>Background:</b> Rebound hypoxemia may occur after cessation of corticosteroid therapy for COVID-19 pneumonitis. We aimed to determine the incidence of this phenomenon in mechanically ventilated patients with COVID-19 completing corticosteroid therapy. <b>Methods:</b> We conducted a retrospective observational cohort study across 2 tertiary ICUs from September to December 2021. We included all adult patients receiving invasive mechanical ventilation on completion of a 10-day course of dexamethasone for COVID pneumonitis. Our primary outcome was change in P_aO₂/F_IO₂ ratio in the 7 days following cessation of dexamethasone. Secondary outcomes included duration of ventilation, frequency of corticosteroid recommencement, and mortality. <b>Results:</b> We studied 88 subjects. Median age was 61 years (interquartile range [IQR] 51-67), and median duration of mechanical ventilation was 14 days (IQR 11-26). On completion of dexamethasone, 62 subjects (70%) remained off corticosteroid therapy for the subsequent 7 days. Of these, 63% (<i>n =</i> 20) had a stable P_aO₂/F_IO₂ ratio on day 7 (mean change 197 ± 42 mm Hg to 258 ± 83 mm Hg). Subjects who had a reduction in P_aO₂/F_IO₂ ratio >20 mm Hg by day 7 (mean change 214 ± 68 mm Hg to 152 ± 78 mm Hg) were more likely to die in hospital (<i>P</i> < .001). These subjects had a higher C-reactive protein level at time of steroid cessation (204 ± 87 mg/L, <i>P</i> = .17), which remained persistently elevated (206 ± 89 mg/L, <i>P</i> = .01) on day 7. The 30% of subjects who recommenced steroids required a longer duration of ventilation (13.5 vs 24.5 d, <i>P</i> = .002) but showed no differences in ICU mortality (19% vs 27%, <i>P</i> = .43). <b>Conclusions:</b> Rebound hypoxemia and steroid recommencement were common occurrences in mechanically ventilated subjects with COVID-19. Rebound hypoxemia was associated with higher mortality. Steroid recommencement was associated with longer duration of mechanical ventilation but no significant difference in mortality.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Weaning Outcomes in Mechanically Ventilated Patients Using Diaphragmatic Excursion With Tissue Doppler Imaging Variables of the Diaphragm.","authors":"Rui Liu, Yuxia Liu, Yi Liang, Chenhong He, Xiaozhen Liu, Shaobo Xin","doi":"10.1089/respcare.12189","DOIUrl":"10.1089/respcare.12189","url":null,"abstract":"<p><p><b>Background:</b> Diaphragmatic excursion is a crucial predictor of extubation outcomes in subjects on mechanical ventilation. However, its measurement can be influenced by various factors, which leads to inconsistent optimal thresholds and accuracy. Tissue Doppler imaging variables of the diaphragm have been established as reliable indicators for predicting extubation outcomes. This study aimed to assess the predictive ability of combining diaphragmatic excursion with tissue Doppler imaging variables of the diaphragm in subjects on mechanical ventilation. <b>Methods:</b> This prospective observational study was conducted from April 2023 to April 2024, eligible subjects who underwent mechanical ventilation for > 48 h and successfully completed a 30-min spontaneous breathing test in the ICU of our center. Diaphragmatic excursion and tissue Doppler imaging variables (including peak contraction velocity, peak relaxation velocity, maximal contraction rate, and maximal relaxation rate) were assessed immediately after a 30-min spontaneous breathing trial. The subjects were categorized into successful extubation and failed extubation groups based on their extubation outcomes. Differences in diaphragmatic ultrasound variables between these groups were analyzed. <b>Results:</b> The study included 63 subjects in the successful extubation group and 28 subjects in the failed extubation group. The area under the receiver operating characteristic curve for diaphragmatic excursion in predicting successful extubation was determined as 0.79 (95% CI, 0.69 ∼ 0.89), with a sensitivity of 82.5% and a specificity of 75.0%. The combined area under the receiver operating characteristic curve for diaphragmatic excursion and tissue Doppler imaging variables (including peak contraction velocity and maximal relaxation rate) in predicting successful extubation was determined as 0.94 (95% CI, 0.88 ∼ 0.99), with a sensitivity of 92.1% and a specificity of 89.3%. <b>Conclusions:</b> Combining diaphragmatic excursion with tissue Doppler imaging variables of the diaphragm enhanced the prediction of extubation outcomes in the subjects on mechanical ventilation compared with diaphragmatic excursion alone.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"408-416"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.","authors":"Anne D Zakrajsek, Lissy Kesterson, Marty O Visscher, Vivek Narendran, Orlando S Hoilett, Eric A Nauman","doi":"10.4187/respcare.12217","DOIUrl":"10.4187/respcare.12217","url":null,"abstract":"<p><p><b>Background:</b> The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive respiratory support. Since most patients receive nasal bubble CPAP a concomitant increase in nasal pressure injuries followed. This prospective observational study aimed to develop strategies to reduce nasal mask pressure injury in neonates by (1) quantifying CPAP mask-interface pressure and (2) assessing placement variability. <b>Methods:</b> A micro-electromechanical systems pressure sensor was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cm H₂O and 8 L/min of flow with no humidification. Pressure was measured at 3 locations (the forehead, nasal bridge, and philtrum) in triplicate (3 measurements/site). Descriptive statistics; a location-specific, one-way analysis of variance with a Tukey post hoc test; and a 2-sample paired <i>t</i> test of the means of the first and last triplicate were performed. <b>Results:</b> Pressure ranged from 12-377.3 mm Hg. The mean [SD] interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum 173.9 [101.3], nasal bridge 67.8 [28.9], and forehead 79.0 [36.9], <i>P</i> < .001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. <b>Conclusions:</b> This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"417-426"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Airway Occlusion Pressure as a Method of Assessing Breathing Effort During Noninvasive Ventilation.","authors":"Emiliano Gogniat, Emilio Steinberg, Norberto Tiribelli, Mariano Setten, Facundo J Gutierrez, Gustavo A Plotnikow","doi":"10.1089/respcare.12324","DOIUrl":"10.1089/respcare.12324","url":null,"abstract":"<p><p><b>Background:</b> The airway-occlusion pressure is used to estimate the muscle pressure (<math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math>) and the occlusion pressure at 100 ms (<math><mrow><msub><mtext>P</mtext><mrow><mtext>0</mtext><mtext>.1</mtext></mrow></msub></mrow></math>) to assess respiratory drive in patients on mechanical ventilation. However, the validity of these maneuvers during noninvasive ventilation (NIV) has not been evaluated. This study was designed to validate the airway-occlusion pressure and the <math><mrow><msub><mtext>P</mtext><mrow><mtext>0</mtext><mtext>.1</mtext></mrow></msub></mrow></math> described for mechanical ventilation during NIV in a bench model. <b>Methods:</b> This was a bench observational prospective study carried out during January and February 2024 in the ICU laboratory of the Hospital Británico of Buenos Aires. <b>Results:</b> In the non-leakage NIV scenarios with oronasal and total face mask, the NIV-airway-occlusion pressure increased with greater <math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math> (<i>P</i> < .001). For a programmed <math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math> of 5 cm H₂O, values around 4.5 cm H₂O were recorded for both oronasal and total face masks. At 10 cm H₂O, the values were ∼8 cm H₂O, and at 15 cm H₂O, they were ∼11 cm H₂O. With leaks, this difference worsened as leakage increased and the effort decreased. In the Bland-Altman analysis between mechanical ventilation-airway-occlusion pressure and NIV-airway-occlusion pressure without leakage for oronasal and total face masks, we found a good agreement for the 3 levels of <math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math> with both types of masks. With regard to the values of NIV-airway-occlusion pressure with the helmet, Bland-Altman analysis showed a high bias and random error. Multivariate analysis found that NIV-airway-occlusion pressure depends on the type of interface, increased with <math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math>, and decreased as leakage increased. The agreement of NIV-<math><mrow><msub><mtext>P</mtext><mrow><mtext>0</mtext><mtext>.1</mtext></mrow></msub></mrow></math> was not good across all noninvasive measurements. <b>Conclusions:</b> This study constitutes a relevant contribution in the validation of indices to assess <math><mrow><msub><mtext>P</mtext><mtext>mus</mtext></msub></mrow></math> during NIV. In a laboratory setting, the measurement of airway-occlusion pressure in NIV may be used to assess effort estimation in the absence of leakage; however, it will likely be underestimated. <math><mrow><msub><mtext>P</mtext><mrow><mtext>0</mtext><mtext>.1</mtext></mrow></msub></mrow></math> proved to be an unreliable method. These findings suggest the feasibility of assessing muscle effort during NIV.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"368-376"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}