Evidence map›Paper›PMID 27342819›Full record

Observational studyIntensive care medicine2016

Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria.

Jeremy R Beitler, Scott A Sands, Stephen H Loring, Robert L Owens, Atul Malhotra, Roger G Spragg, Michael A Matthay, B Taylor Thompson, Daniel Talmor

2 registry-linked trialsOpen access · greenAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 93 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
93citing papers in PubMed, 2 pooled it
13.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03376854 phase2withdrawnnot on this mapstarted 2018, after this paper: background citation

Pilot Randomized Clinical Trial of Therapeutic Hypothermia Plus Neuromuscular Blockade vs. Standard of Care in COVID-19 Patients With Moderate to Severe ARDS - the Cooling to Help Injured Lungs (CHILL) Pilot Study

TypeinterventionalSponsorUniversity of Maryland, BaltimoreRan2018 to 2021Enrolled0ConditionsRespiratory Distress Syndrome, Adult, Sars-CoV2ArmsHypothermia, Neuromuscular Blocking Agents, Standard of Care
NCT04545424 phase2recruitingnot on this mapstarted 2021, after this paper: background citation

Cooling to Help Injured Lungs (CHILL) Phase IIB Randomized Control Trial of Therapeutic Hypothermia in Patients With ARDS

TypeinterventionalSponsorUniversity of Maryland, BaltimoreRan2021 to 2026Enrolled340ConditionsRespiratory Distress Syndrome, AdultArmsHypothermia, Neuromuscular Blocking Agents, Standard of care
3 · Its place in the literature

Who cites it

93 citing papers in PubMed, 2 syntheses or guidelines pooled it, 213 citations in OpenAlex.

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33 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 1 country.

Jeremy R BeitlerDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, 200 West Arbor Drive, #8409, San Diego, CA, 92103, USA. jbeitler@ucsd.edu.
Scott A SandsDivision of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Stephen H LoringDepartment of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Robert L OwensDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, 200 West Arbor Drive, #8409, San Diego, CA, 92103, USA.
Atul MalhotraDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, 200 West Arbor Drive, #8409, San Diego, CA, 92103, USA.
Roger G SpraggDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, 200 West Arbor Drive, #8409, San Diego, CA, 92103, USA.
Michael A MatthayDepartments of Medicine and Anesthesia, and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA.
B Taylor ThompsonDivision of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
Daniel TalmorDepartment of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Beth Israel Deaconess Medical Center · USUniversity of California, San Diego · USUniversity of California System · USCircadian (United States) · USMassachusetts General Hospital · USUniversity of California, San Francisco · US

Funding

RESPIRATORY RESEARCHT32HL007633 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI George R Washko · 1985 to 2026
$14.9M
Sub Project 2UM1HL108724 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI LORING, STEPHEN H, TALMOR, DANIEL STUART · 2012 to 2014
$4.6M
Single Motor Unit Genioglossus Recordings to Understand Sleep Apnea PathogenesisR01HL085188 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2008 to 2018
$3.5M
Training in the Next Generation in Respiratory ScienceT32HL134632 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL, POWELL, FRANK L. · 2017 to 2021
$2.1M
Assessment of Upper Airway Mechanics Using Newer Electromyographic TechniquesK24HL132105 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2016 to 2020
$611k
NHLBI NIH HHS K24 HL132105NHLBI NIH HHS L30 HL129438NHLBI NIH HHS R01 HL085188NHLBI NIH HHS T32 HL007633NHLBI NIH HHS T32 HL134632NHLBI NIH HHS UM1 HL108724
6 · The paper itself

Abstract

purposeBreath stacking dyssynchrony generates higher tidal volumes than intended, potentially increasing lung injury risk in acute respiratory distress syndrome (ARDS). Lack of validated criteria to quantify breath stacking dyssynchrony contributes to its under-recognition. This study evaluates performance of novel, objective criteria for quantifying breath stacking dyssynchrony (BREATHE criteria) compared to existing definitions and tests if neuromuscular blockade eliminates high-volume breath stacking dyssynchrony in ARDS.

methodsAirway flow and pressure were recorded continuously for up to 72 h in 33 patients with ARDS receiving volume-preset assist-control ventilation. The flow-time waveform was integrated to calculate tidal volume breath-by-breath. The BREATHE criteria considered five domains in evaluating for breath stacking dyssynchrony: ventilator cycling, interval expiratory volume, cumulative inspiratory volume, expiratory time, and inspiratory time.

resultsThe observed tidal volume of BREATHE stacked breaths was 11.3 (9.7-13.3) mL/kg predicted body weight, significantly higher than the preset volume [6.3 (6.0-6.8) mL/kg; p < 0.001]. BREATHE identified more high-volume breaths (≥2 mL/kg above intended volume) than the other existing objective criteria for breath stacking [27 (7-59) vs 19 (5-46) breaths/h; p < 0.001]. Agreement between BREATHE and visual waveform inspection was high (raw agreement 96.4-98.1 %; phi 0.80-0.92). Breath stacking dyssynchrony was near-completely eliminated during neuromuscular blockade [0 (0-1) breaths/h; p < 0.001].

conclusionsThe BREATHE criteria provide an objective definition of breath stacking dyssynchrony emphasizing occult exposure to high tidal volumes. BREATHE identified high-volume breaths missed by other methods for quantifying this dyssynchrony. Neuromuscular blockade prevented breath stacking dyssynchrony, assuring provision of the intended lung-protective strategy.

Indexed as

AdultAgedFemaleHumansInhalationMaleMiddle AgedReference ValuesRespiration, ArtificialRespiratory Distress SyndromeRespiratory Function TestsRespiratory RateTidal VolumeVentilator-Induced Lung InjuryVentilators, MechanicalAcute lung injuryAcute respiratory distress syndromeMechanical ventilationPatient–ventilator dyssynchronyRespiratory mechanicsVentilator-induced lung injury

Identifiers

PMID27342819
PMCPMC4992404
OpenAlexW2463144296

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.