ArticleCritical care medicine2021
Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients.
Article in Critical care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 43 citations in OpenAlex.
- Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy.Critical care (London, England) · 2023Trial
- Trial
- Lung- and diaphragm-protective mechanical ventilation in acute respiratory distress syndrome.Intensive care medicine · 2026Review
- The invasive and non-invasive monitoring of inspiratory effort and drive during assisted mechanical ventilation.Annals of intensive care · 2026Review
- Assessment of V/Q mismatch during pressure support ventilation with electrical impedance tomography: a prospective physiological study.Intensive care medicine experimental · 2025Article
- Assessing inspiratory drive and effort in critically ill patients at the bedside.Critical care (London, England) · 2025Review
- Effects of cipepofol on breathing patterns, respiratory drive, and inspiratory effort in mechanically ventilated patients.Frontiers in medicine · 2025Article
- Assessing agreement among non-invasive indicators for inspiratory effort during pressure support ventilation.Frontiers in medicine · 2025Article
- Article
- The level of partial pressure of carbon dioxide affects respiratory effort in COVID-19 patients undergoing pressure support ventilation with extracorporeal membrane oxygenation.BMC anesthesiology · 2024Article
- Use of pressure muscle index to predict the contribution of patient's inspiratory effort during pressure support ventilation: a prospective physiological study.Frontiers in medicine · 2024Article
- A cluster randomized trial on inspiratory effort-targeted pressure support adjustment strategy in patients undergoing assisted mechanical ventilation: protocol for the IT-PSV study.Frontiers in medicine · 2024Article
- Individual response in patient's effort and driving pressure to variations in assistance during pressure support ventilation.Annals of intensive care · 2023Article
- Use of airway pressure-based indices to detect high and low inspiratory effort during pressure support ventilation: a diagnostic accuracy study.Annals of intensive care · 2023Article
- Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2023Review
- Validation of the flow index to detect low inspiratory effort during pressure support ventilation.Annals of intensive care · 2022Article
- Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.Critical care (London, England) · 2022Observational
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivesInspiratory holds with measures of airway pressure to estimate driving pressure (elastic work) are often limited to patients without respiratory effort. We sought to evaluate if measures of airway pressure during inspiratory holds could be used for patients with spontaneous respiratory effort during mechanical ventilation to estimate the degree of spontaneous effort and elastic work.
designWe compared the direction and degree of change in airway pressure during inspiratory holds versus esophageal pressure through secondary analysis of physiologic data.
settingICUs at Children's Hospital Los Angeles. PATIENTS: Children with pediatric acute respiratory distress syndrome with evidence of spontaneous respiration while on pressure control or pressure support ventilation.
interventionsInspiratory hold maneuvers. MEASUREMENTS AND MAIN
resultsFrom airway pressure, we defined "plateau - peak pressure" as Pmusc, index, which was divided into three categories for analysis (< -1 ["negative"], between -1 and 1 ["neutral"], and > 1 cm H2O ["positive"]). A total of 30 children (age 36.8 mo [16.1-70.3 mo]) from 65 study days, comprising 118 inspiratory holds were included. Pmusc, index was "negative" in 29 cases, was "neutral" in 17 cases, and was "positive" in 72 cases. As Pmusc, index went from negative to neutral to positive, there was larger negative deflection in esophageal pressure -5.0 (-8.2 to 1.9), -5.9 (-7.6 to 4.3), and -10.7 (-18.1 to 7.9) cm H2O (p < 0.0001), respectively. There was a correlation between max negative esophageal pressure and Pmusc, index (r = -0.52), and when Pmusc, index was greater than or equal to 7 cm H2O, the max negative esophageal pressure was greater than 10 cm H2O. There was a stronger correlation between Pmusc, index and markers of elastic work from esophageal pressure (r = 0.84).
conclusionsThe magnitude of plateau minus peak pressure during an inspiratory hold is correlated with the degree of inspiratory effort, particularly for those with high elastic work. It may be useful to identify patients with excessively high effort or high driving pressure.
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