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
- 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 care, 7(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 medicine, 44(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).
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