Continuous monitoring of intrinsic PEEP based on expired CO2 kinetics: An experimental validation study

A. Naya Prieto (Madrid, Spain), C. López Chang (Madrid, Spain), L. De La Dueña Muñoz (Madrid, Spain), P. Carballosa De Miguel (Madrid, Spain), I. Fernandez Ormaechea (Madrid, Spain), F. Suarez Sipmann (Madrid, Spain), A. Santos Oviedo (Madrid, Spain), C. Castilla Reparaz (Madrid, Spain), P. Zazu López (Madrid, Spain), J. Reyes Ussetti (Madrid, Spain), M. Rodríguez Nieto (Madrid, Spain), G. Peces-Barba Romero (Madrid, Spain), S. Heili Frades (Madrid, Spain)

Source: Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome - Acute respiratory failure: Physiology

Session: Acute respiratory failure: Physiology
Session type: Oral poster discussion
Number: 138

Abstract

Background:Quantification of intrinsic PEEP (PEEPi) has important implications for patients subjected to invasive mechanical ventilation. A new non-invasive-breath-by-breath method (etCO₂D) for determination of PEEPi is evaluated.

Methods:In 12 mechanically ventilated pigs, dynamic hyperinflation was induced by interposing a resistance in the endotracheal tube. Airway pressure, flow and exhaled CO2 were measured at the airway opening. Combining different I:E ratios, respiratory rates and tidal volumes, 52 different levels of PEEPi (range 1,8-11,7 cmH₂O;mean 8,45±0,32 cmH₂O) were studied. The etCO₂D is based on the detection of the end-tidal dilution of the capnogram.This is measured at the airway opening by means of a CO₂sensor in which a 2-mm leak is added to the sensing chamber. This allows to detect a capnogram dilution with fresh air when the pressure coming from the ventilator exceeds the PEEPi. This method was compared with the occlusion method OM.

Results: The etCO₂D method detected PEEPi step changes of 0,2 cmH₂O. Reference and etCO₂D PEEPi presented a good correlation (R² 0,8, p<0,0001) and good agreement, bias -0,26, and limits of agreement ±1,96 SD (2,23-2,74) (p<0,0001).

Conclusions: The etCO₂D method is a promising way to continuosly monitor PEEPi. The etCO₂D method measures PEEPi-dyn, so differences with the OM are expected to be larger in heterogeneous lungs and could thus monitor lung heterogeneity.

Heili-Frades et al. Critical Care (2019) 23:192

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Citations should be made in the following way:
A. Naya Prieto (Madrid, Spain), C. López Chang (Madrid, Spain), L. De La Dueña Muñoz (Madrid, Spain), P. Carballosa De Miguel (Madrid, Spain), I. Fernandez Ormaechea (Madrid, Spain), F. Suarez Sipmann (Madrid, Spain), A. Santos Oviedo (Madrid, Spain), C. Castilla Reparaz (Madrid, Spain), P. Zazu López (Madrid, Spain), J. Reyes Ussetti (Madrid, Spain), M. Rodríguez Nieto (Madrid, Spain), G. Peces-Barba Romero (Madrid, Spain), S. Heili Frades (Madrid, Spain). Continuous monitoring of intrinsic PEEP based on expired CO2 kinetics: An experimental validation study. Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome - Acute respiratory failure: Physiology

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