Research on the effects of mechanical ventilation with titrating positive end-expiratory pressure guided by esophageal pressure in patients with acute respiratory distress syndrome

  • Ngo Trong Toan National Geriatric Hospital
  • Dao Xuan Co Bach Mai Hospital
  • Nguyen Manh Dung 108 Military Central Hospital

Main Article Content

Keywords

Esophageal pressure-guided ventilation, esophageal pressure, pleural pressure, transpulmonary pressure

Abstract

Summary


Objective: To assess effects of mechanical ventilation with titrating positive end-expiratory pressure (PEEP) guided by esophageal pressure in patients with acute respiratory distress syndrome (ARDS). Subject and method: Prospective, randomized, intervened study. We randomly assigned 34 patients with moderate and severe ARDS to undergo mechanical ventilation with PEEP adjusted according to EPVent2 and 34 patients with moderate and severe ARDS to undergo mechanical ventilation with PEEP adjusted according to low PEEP table of ARDSnetwork (the control group). Result: The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen at T1 and T2 were higher in the EPVent2 group than the control group (p<0,001). The mortality rate at 28 days was lower among the EPVent2 group than among the control group, but the difference was not significant (p>0,05). Conclusion: The EPVent2 improves PaO2/FiO2 but not improve mortality rate.


              Keywords: Esophageal pressure-guided ventilation, esophageal pressure, pleural pressure, transpulmonary pressure.

Article Details

References

1. Dương Đức Mạnh, Ngô Trọng Toàn, Nguyễn Công Tấn (2016) Đánh giá vai trò của kỹ thuật đo áp lực thực quản trong lựa chọn mức PEEP ở bệnh nhân ARDS. Y học Việt Nam, 449(2), tr. 151-155.
2. Beitler JR, Sarge T, Banner-Goodspeed VM et al EPVent-2 Group (2019) Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: A randomized clinical trial. JAMA 321(9): 846-857.
3. Chen L, Chen GQ, Shore K et al (2017) Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome. Critical Care 21(84).
4. Deutschman CS, Neligan PJ (2010) Acute lung injury and ARDS. Evidence-Based Practice of Critical Care, Saunders Elsevier, Philadelphia: 61-147.
5. Fish E, Novack V, Banner-Goodspeed VM et al (2014) The esophageal pressure-guided ventilation 2 (EPVent2) trial protocol: A multicentre, randomized clinical trial of mechanical ventilation guided by transpulmonary pressure. BMJ Open 4(9).
6. Grasso S, Terragni P, Birocco A et al (2012) ECMO criteria for influenza A (H1N1)-associated ARDS: Role of transpulmonary pressure. Intensive Care Med 38: 395-403.
7. Talmor D, Sarge T, Malhotra A et al (2008) Mechanical ventilation guided by esophageal pressure in acute lung injury. The new england journal of medicine 359(20): 2095-2104.
8. Yang Y, Li Y, Liu SQ et al (2013) Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension. Chin Med J 126(17): 3234-3239.

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Published
Jul 7, 2020
Issue
Volume 15 - No 7/2020
Section
Articles
How to Cite
Trong ToanN., Xuan CoD., & Manh DungN. (2020). Research on the effects of mechanical ventilation with titrating positive end-expiratory pressure guided by esophageal pressure in patients with acute respiratory distress syndrome. Tạp Chí Y Dược lâm sàng 108, 15(7). Retrieved from https://tcydls108.benhvien108.vn/index.php/YDLS/article/view/472