학술논문
Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study
Document Type
Academic Journal
Author
Tonelli, Roberto; Grasso, Salvatore; Cortegiani, Andrea; Ball, Lorenzo; Castaniere, Ivana; Tabbì, Luca; Fantini, Riccardo; Andrisani, Dario; Gozzi, Filippo; Moretti, Antonio; Bruzzi, Giulia; Manicardi, Linda; Cerri, Stefania; Samarelli, Anna Valeria; Raineri, Giulia; Murgolo, Francesco; Carzoli, Andrea; Di Mussi, Rossella; Busani, Stefano; Rizzoni, Raffaella; Grasselli, Giacomo; Clini, Enrico; Marchioni, Alessandro
Source
Critical Care. October 18, 2023, Vol. 27 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): Roberto Tonelli[sup.1,2,3], Salvatore Grasso[sup.4], Andrea Cortegiani[sup.5,6], Lorenzo Ball[sup.7,8], Ivana Castaniere[sup.1,3], Luca Tabbì[sup.1], Riccardo Fantini[sup.1], Dario Andrisani[sup.1,2,3], Filippo Gozzi[sup.1,2,3], Antonio Moretti[sup.1,3], Giulia Bruzzi[sup.1,3], Linda Manicardi[sup.1,3], Stefania Cerri[sup.1,3], Anna Valeria Samarelli[sup.1,3], [...]
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.sub.2/FiO.sub.2 ratio). Three PEEP levels (zero = ZEEP, 4-8 cmH.sub.2O = PEEP.sub.LOW, and titrated to achieve positive end-expiratory transpulmonary pressure P.sub.L,EE = PEEP.sub.TITRATED) were used for measurements. Results Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median P.sub.L,EE at ZEEP was - 4.3 [- 7.6- - 2.3] cmH.sub.2O and lung elastance (E.sub.L) 44 [40-51] cmH.sub.2O/L. At PEEP.sub.LOW, P.sub.L,EE remained negative and E.sub.L did not change (p = 0.995) versus ZEEP. At PEEP.sub.TITRATED, P.sub.L,EE increased to 0.8 [0.3-1.5] cmH.sub.2O and E.sub.L to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEP.sub.LOW, respectively). [DELA]P.sub.L decreased at PEEP.sub.LOW (p = 0.018) and increased at PEEP.sub.TITRATED (p = 0.003). In matched ARDS control PEEP titration to obtain a positive P.sub.L,EE did not result in significant changes in E.sub.L and [DELA]P.sub.L. Conclusions In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive P.sub.L,EE significantly worsened lung mechanics. Keywords: Interstitial lung disease, Pulmonary fibrosis, Usual interstitial pneumonia, Acute respiratory failure, ARDS, Lung elastance, Lung elastance, Respiratory mechanics, End-inspiratory transpulmonary pressure, End-expiratory transpulmonary pressure, Invasive mechanical ventilation, VILI, Transpulmonary pressure
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.sub.2/FiO.sub.2 ratio). Three PEEP levels (zero = ZEEP, 4-8 cmH.sub.2O = PEEP.sub.LOW, and titrated to achieve positive end-expiratory transpulmonary pressure P.sub.L,EE = PEEP.sub.TITRATED) were used for measurements. Results Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median P.sub.L,EE at ZEEP was - 4.3 [- 7.6- - 2.3] cmH.sub.2O and lung elastance (E.sub.L) 44 [40-51] cmH.sub.2O/L. At PEEP.sub.LOW, P.sub.L,EE remained negative and E.sub.L did not change (p = 0.995) versus ZEEP. At PEEP.sub.TITRATED, P.sub.L,EE increased to 0.8 [0.3-1.5] cmH.sub.2O and E.sub.L to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEP.sub.LOW, respectively). [DELA]P.sub.L decreased at PEEP.sub.LOW (p = 0.018) and increased at PEEP.sub.TITRATED (p = 0.003). In matched ARDS control PEEP titration to obtain a positive P.sub.L,EE did not result in significant changes in E.sub.L and [DELA]P.sub.L. Conclusions In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive P.sub.L,EE significantly worsened lung mechanics. Keywords: Interstitial lung disease, Pulmonary fibrosis, Usual interstitial pneumonia, Acute respiratory failure, ARDS, Lung elastance, Lung elastance, Respiratory mechanics, End-inspiratory transpulmonary pressure, End-expiratory transpulmonary pressure, Invasive mechanical ventilation, VILI, Transpulmonary pressure