Particle flow rate from the airways as fingerprint diagnostics in mechanical ventilation in the intensive care unit : A randomised controlled study
(2021) In ERJ open research 7(3).- Abstract
Introduction Mechanical ventilation can be monitored by analysing particles in exhaled air as measured by particle flow rate (PFR). This could be a potential method of detecting ventilator-induced lung injury (VILI) before changes in conventional parameters can be detected. The aim of this study was to investigate PFR during different ventilation modes in patients without lung pathology. Method A prospective study was conducted on patients on mechanical ventilation in the cardiothoracic intensive care unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the ventilator for continuous measurement of PFR in 30 patients randomised to either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) for 30... (More)
Introduction Mechanical ventilation can be monitored by analysing particles in exhaled air as measured by particle flow rate (PFR). This could be a potential method of detecting ventilator-induced lung injury (VILI) before changes in conventional parameters can be detected. The aim of this study was to investigate PFR during different ventilation modes in patients without lung pathology. Method A prospective study was conducted on patients on mechanical ventilation in the cardiothoracic intensive care unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the ventilator for continuous measurement of PFR in 30 patients randomised to either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) for 30 min including a recruitment manoeuvre. PFR measurements were continued as the patients were transitioned to pressure-regulated volume control (PRVC) and then pressure support ventilation (PSV) until extubation. Results PRVC resulted in significantly lower PFR, while those on PSV had the highest PFR. The distribution of particles differed significantly between the different ventilation modes. Conclusions Measuring PFR is safe after cardiac surgery in the ICU and may constitute a novel method of continuously monitoring the small airways in real time. A low PFR during mechanical ventilation may correlate to a gentle ventilation strategy. PFR increases as the patient transitions from controlled mechanical ventilation to autonomous breathing, which most likely occurs as recruitment by the diaphragm opens up more distal airways. Different ventilation modes resulted in unique particle patterns and could be used as a fingerprint for the different ventilation modes.
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- author
- Hallgren, Filip ; Stenlo, Martin LU ; Niroomand, Anna LU ; Broberg, Ellen LU ; Hyllén, Snejana LU ; Malmsjö, Malin LU and Lindstedt, Sandra LU
- organization
-
- StemTherapy: National Initiative on Stem Cells for Regenerative Therapy
- Anesthesiology and Intensive Care
- Thoracic Surgery
- Pediatric anesthesia and intensive care (research group)
- Clinical and experimental lung transplantation (research group)
- Ophthalmology, Lund
- Ophthalmology Imaging Research Group (research group)
- NPWT technology (research group)
- WCMM-Wallenberg Centre for Molecular Medicine
- Lung Bioengineering and Regeneration (research group)
- DCD transplantation of lungs (research group)
- publishing date
- 2021-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- ERJ open research
- volume
- 7
- issue
- 3
- article number
- 00961-2020
- publisher
- European Respiratory Society
- external identifiers
-
- scopus:85115690547
- pmid:34322553
- ISSN
- 2312-0541
- DOI
- 10.1183/23120541.00961-2020
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © The authors 2021.
- id
- 892200d7-c7ee-4ef4-ab98-a2ba9389ff8f
- date added to LUP
- 2021-11-01 13:13:45
- date last changed
- 2024-06-15 19:33:42
@article{892200d7-c7ee-4ef4-ab98-a2ba9389ff8f, abstract = {{<p>Introduction Mechanical ventilation can be monitored by analysing particles in exhaled air as measured by particle flow rate (PFR). This could be a potential method of detecting ventilator-induced lung injury (VILI) before changes in conventional parameters can be detected. The aim of this study was to investigate PFR during different ventilation modes in patients without lung pathology. Method A prospective study was conducted on patients on mechanical ventilation in the cardiothoracic intensive care unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the ventilator for continuous measurement of PFR in 30 patients randomised to either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) for 30 min including a recruitment manoeuvre. PFR measurements were continued as the patients were transitioned to pressure-regulated volume control (PRVC) and then pressure support ventilation (PSV) until extubation. Results PRVC resulted in significantly lower PFR, while those on PSV had the highest PFR. The distribution of particles differed significantly between the different ventilation modes. Conclusions Measuring PFR is safe after cardiac surgery in the ICU and may constitute a novel method of continuously monitoring the small airways in real time. A low PFR during mechanical ventilation may correlate to a gentle ventilation strategy. PFR increases as the patient transitions from controlled mechanical ventilation to autonomous breathing, which most likely occurs as recruitment by the diaphragm opens up more distal airways. Different ventilation modes resulted in unique particle patterns and could be used as a fingerprint for the different ventilation modes.</p>}}, author = {{Hallgren, Filip and Stenlo, Martin and Niroomand, Anna and Broberg, Ellen and Hyllén, Snejana and Malmsjö, Malin and Lindstedt, Sandra}}, issn = {{2312-0541}}, language = {{eng}}, month = {{07}}, number = {{3}}, publisher = {{European Respiratory Society}}, series = {{ERJ open research}}, title = {{Particle flow rate from the airways as fingerprint diagnostics in mechanical ventilation in the intensive care unit : A randomised controlled study}}, url = {{http://dx.doi.org/10.1183/23120541.00961-2020}}, doi = {{10.1183/23120541.00961-2020}}, volume = {{7}}, year = {{2021}}, }