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Performance and applications of bedside visual inspection of airway pressure–time curve profiles for estimating stress index in patients with acute respiratory distress syndrome

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Abstract

To determine the performance of bedside visual inspection of airway pressure-time (Paw–t) curve profiles (VI) for estimating stress index (SI) in patients with acute respiratory distress syndrome (ARDS). A prospective study in 30 subjects with ARDS receiving mechanical ventilation at two peak inspiratory flow (PIF) settings: 60 or 40 L/min. For each study session, two physicians inspected real-time Paw–t waveforms from mechanical ventilator’s monitoring screens at bedside for 30 s and interpreted which of the three patterns (tidal recruitment, noninjurious ventilation or tidal overdistension) the Paw–t curve profile was compatible with. Subsequently, the study was repeated again at the second PIF setting. SI was derived from a standardized dedicated software program and categorized into three groups: SI < 0.9, or tidal recruitment; SI = 0.9–1.05, or noninjurious ventilation; and SI > 1.05, or tidal overdistension. The lower PIF setting increased the sensitivity of VI to correctly estimate SI (75% vs. 50%; p = 0.005). At PIF 40 L/min, the likelihood ratio of a positive test was 3.6, 5.4 or 7 if the Paw–t curve profile was interpreted as noninjurious ventilation, tidal recruitment or tidal overdistension, respectively. The likelihood ratio of a negative test ranged from 0.55 for tidal recruitment to 0.32 and 0.19 for noninjurious ventilation and tidal overdistension, respectively. Experience in mechanical ventilation did not influence the accuracy. Bedside VI is moderately accurate for estimating SI and may be used to monitor injurious ventilation in patients with ARDS, in addition to plateau airway pressure.

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Abbreviations

Pplat:

End-inspiratory plateau airway pressure

SI:

Stress index

Paw–t:

Airway pressure–time

VI:

Visual inspection of airway pressure–time curve profiles

PIF:

Peak inspiratory flow

VT :

Tidal volume

BF:

Baseline flow

LF:

Lower flow

LE:

Less experience

ME:

More experience

LR:

Likelihood ratio

PLR:

Likelihood ratio of a positive test

NLR:

Likelihood ratio of a negative test

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Acknowledgements

The authors would like to express their appreciation to Khemajira Karaketklang for statistical assistance; and Sarun Kraivee for his technical assistance with ‘Datalogger’.

Funding

This research received no specific grants from any funding agency in the public, commercial, or non-profit sectors.

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Authors and Affiliations

  1. Division of Respiratory Disease, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand

    Phunsup Wongsurakiat & Nadwipa Yuangtrakul

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  1. Phunsup Wongsurakiat
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  2. Nadwipa Yuangtrakul
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Contributions

PW is guarantor for the entire manuscript. PW contributed to the conception, hypothesis, outline, and design of the study; data acquisition; data analysis; drafting the manuscript; and substantial involvement in its revision prior to submission. NY contributed to the design of the study; data acquisition; drafting the manuscript; and substantial involvement in its revision prior to submission.

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Correspondence to Phunsup Wongsurakiat.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants or the participants’next of kin.

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Wongsurakiat, P., Yuangtrakul, N. Performance and applications of bedside visual inspection of airway pressure–time curve profiles for estimating stress index in patients with acute respiratory distress syndrome. J Clin Monit Comput 33, 281–290 (2019). https://doi.org/10.1007/s10877-018-0153-0

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  • DOI: https://doi.org/10.1007/s10877-018-0153-0

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