by Yi Chi, Zhanqi Zhao, Inéz Frerichs, Yun Long and Huaiwu
He
Annals of
Intensive Care volume 12,
Article number: 22 (2022) Published: 05
March 2022
Background
Respiratory pendelluft phenomenon, defined as intrapulmonary
gas redistribution caused by asynchronous alveolar ventilation, could be
potentially harmful by inducing lung injury. The aim of the present study was
to investigate its prevalence and prognosis in intensive care unit (ICU)
patients with acute respiratory failure (ARF).
Methods
This was a retrospective observational study on 200
mechanically ventilated ARF patients treated in a tertiary ICU. The presence of
pendelluft was determined using electrical impedance tomography (EIT) within
48 h after admission. Its amplitude was defined as the impedance
difference between the sum of all regional tidal impedance variation and the
global tidal impedance variation. A value above 2.5% (the 95th percentile from
30 healthy volunteers) was considered confirmative for its occurrence.
Results
Pendelluft was found in 61 patients (39 in 94 patients with
spontaneous breathing, 22 in 106 receiving controlled ventilation), with an
overall prevalence of 31%. Existence of spontaneous breathing and higher global
inhomogeneity index were associated with pendelluft. Patients with pendelluft
had a longer ICU length of stay [10 (6, 14) vs. 7 (4, 11) days; median (lower,
upper quartile); p = 0.022] and shorter 14-day ventilator-free days [8 (1,
10) vs. 10 (6, 12) days; p = 0.015]. Subgroup survival analysis suggested
the association between pendelluft and longer ventilation duration, which was
significant only in patients with PaO2/FiO2 ratio below 200 mmHg
(log-rank p = 0.042). ICU mortality did not differ between the patients
with and without pendelluft.
Conclusions
Respiratory pendelluft occurred often in our study group and
it was associated with longer ventilation duration. Early recognition of this
phenomenon should trigger interventions aimed at alleviating pendelluft.
No comments:
Post a Comment