Test your IntelliVence (Vol 17 Issue 2)

11.05.2020
Author: Simon Franz, Reviewer: Munir Karjaghli, Bernhard Schmitt

This intubated patient is suffering from COVID-19 pneumonia and is currently in the weaning phase of mechanical ventilation. What can we see from the pressure waveform?

Answer: The patient shows a significant drop in pressure during the first 100 ms of inspiration. In the case of such a drop, it may be helpful to assess the airway occlusion pressure (P0.1).  A greater P0.1 (absolute value) can be a sign of a high respiratory drive during mechanical ventilation, which may potentially lead to patient self-inflicted lung injury (P-SILI). Commonly, a value of 3.5 cmH20 is used as a threshold.

Tip: HAMILTON-G5/S1* ventilators provide you with a breath-by-breath measurement of P0.1 if you set pressure trigger. P0.1 can also be configured as a parameter in the Vent Status panel. On HAMILTON-C1/C2/C3/C6*/T1/MR1 ventilators, P0.1 is always available as a breath-by-breath measurement.

* Ventilators not available in all markets

Sources

  • Rittayamai, N., Beloncle, F., Goligher, E. C., Chen, L., Mancebo, J., Richard, J. C. M., & Brochard, L. (2017). Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort. Annals of intensive care7(1), 100.
  • Telias, I., Damiani, F., & Brochard, L. (2018). The airway occlusion pressure (P 0.1) to monitor respiratory drive during mechanical ventilation: increasing awareness of a not-so-new problem. Intensive care medicine44(9), 1532-1535.
  • Telias, I., Junhasavasdikul, D., Rittayamai, N., Piquilloud, L., Chen, L., Ferguson, N. D., ... & Brochard, L. (2020). Airway Occlusion Pressure as an Estimate of Respiratory Drive and Inspiratory Effort During Assisted Ventilation. American Journal of Respiratory and Critical Care Medicine, (ja).

Related Articles

p0.1, pressure drop, weaning, spontaneous, P-SILI, lung injury, self-inflicted
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Date of Printing: 13.08.2020
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The content of this newsletter is for informational purposes only and is not intended to be a substitute for professional training or for standard treatment guidelines in your facility. Any recommendations made in this newsletter with respect to clinical practice or the use of specific products, technology or therapies represent the personal opinion of the author only, and may not be considered as official recommendations made by Hamilton Medical AG. Hamilton Medical AG provides no warranty with respect to the information contained in this newsletter and reliance on any part of this information is solely at your own risk.