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Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.
Tonelli, Roberto; Cortegiani, Andrea; Marchioni, Alessandro; Fantini, Riccardo; Tabbì, Luca; Castaniere, Ivana; Biagioni, Emanuela; Busani, Stefano; Nani, Chiara; Cerbone, Caterina; Vermi, Morgana; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Pellegrino, Maria Rosaria; Beghè, Bianca; Girardis, Massimo; Pelosi, Paolo; Gregoretti, Cesare; Ball, Lorenzo; Clini, Enrico.
  • Tonelli R; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Cortegiani A; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
  • Marchioni A; Department of Surgical, Oncological and Oral Science (DiChirOnS), University of Palermo, Palermo, Italy.
  • Fantini R; Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
  • Tabbì L; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy. marchioni.alessandro@unimore.it.
  • Castaniere I; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Biagioni E; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Busani S; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Nani C; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
  • Cerbone C; Intensive Care Unit, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Vermi M; Intensive Care Unit, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Gozzi F; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Bruzzi G; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Manicardi L; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Pellegrino MR; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Beghè B; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
  • Girardis M; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Pelosi P; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Gregoretti C; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Ball L; Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
  • Clini E; Intensive Care Unit, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
Crit Care ; 26(1): 70, 2022 03 24.
Article in English | MEDLINE | ID: covidwho-2064832
ABSTRACT

BACKGROUND:

Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔPes) and nasal (ΔPnos) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF.

METHODS:

From January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of non-invasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 h after starting NRS. Correlation between ΔPes and ΔPnos served as primary outcome. The effect of ΔPnos measurements on respiratory rate and ΔPes was also assessed.

RESULTS:

ΔPes and ΔPnos were strongly correlated at admission (R2 = 0.88, p < 0.001) and 24 h apart (R2 = 0.94, p < 0.001). The nasal plug insertion and the mouth closure required for ΔPnos measurement did not result in significant change of respiratory rate and ΔPes. The correlation between measures at 24 h remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R2 = 0.79, p < 0.001] or non-invasive ventilation [R2 = 0.95, p < 0.001]).

CONCLUSIONS:

In a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. ΔPnos might warrant further investigation as a measure of inspiratory effort in patients with ARF. TRIAL REGISTRATION NCT03826797 . Registered October 2016.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-03938-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-03938-w