Details

Autor(en) / Beteiligte

• Tonelli, Roberto
• Fantini, Riccardo
• Tabbì, Luca
• Castaniere, Ivana
• Pisani, Lara
• Pellegrino, Maria Rosaria
• Della Casa, Giovanni
• D'Amico, Roberto
• Girardis, Massimo
• Nava, Stefano
• Clini, Enrico M
• Marchioni, Alessandro

Titel

Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Ist Teil von

• American journal of respiratory and critical care medicine, 2020-08, Vol.202 (4), p.558-567

Ort / Verlag

United States: American Thoracic Society

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic respiratory failure. To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Thirty consecutive patients with acute hypoxic respiratory failure admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal change in esophageal pressure (ΔPes), tidal change in dynamic transpulmonary pressure (ΔPl), expiratory Vt, and respiratory rate were recorded on admission and 2-4 to 12-24 hours after NIV start and were tested for correlation with outcomes. ΔPes and ΔPes/ΔPl ratio were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (  = 18) compared with those who needed endotracheal intubation (  = 12) (median [interquartile range], 11 [8-15] cm H O vs. 31.5 [30-36] cm H O;  < 0.0001), whereas other variables differed later. ΔPes was not related to other predictors of NIV failure at baseline. NIV-induced reduction in ΔPes of 10 cm H O or more after 2 hours of treatment was strongly associated with avoidance of intubation and represented the most accurate predictor of treatment success (odds ratio, 15; 95% confidence interval, 2.8-110;  = 0.001 and area under the curve, 0.97; 95% confidence interval, 0.91-1;  < 0.0001). The magnitude of inspiratory effort relief as assessed by ΔPes variation within the first 2 hours of NIV was an early and accurate predictor of NIV outcome at 24 hours.Clinical trial registered with www.clinicaltrials.gov (NCT03826797).