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Intensive Care Medicine

, Volume 44, Issue 9, pp 1532–1535 | Cite as

The airway occlusion pressure (P0.1) to monitor respiratory drive during mechanical ventilation: increasing awareness of a not-so-new problem

  • Irene Telias
  • Felipe Damiani
  • Laurent BrochardEmail author
What's New in Intensive Care

Importance of monitoring respiratory drive during mechanical ventilation

An inadequate respiratory drive under mechanical ventilation, either too high or too low, has recently been incriminated as a risk factor for both lung [ 1] and diaphragmatic injury [ 2]. Monitoring and controlling the drive to breathe might, therefore, be important for clinical practice. However, respiratory drive assessment has mostly been limited to research purposes, with few techniques available at the bedside [ 3]. A simple non-invasive measure, the airway occlusion pressure ( P 0.1), i.e. the pressure developed in the occluded airway 100 ms after the onset of inspiration (Fig.  1), was first described 40 years ago. Currently, nearly all modern ventilators provide a means of measuring P 0.1. Despite having a better understanding of the importance of the respiratory drive during mechanical ventilation, no recommendations exist about its use.

Notes

Acknowledgements

Funding was provided by Keenan Chair in Critical Care and Acute Respiratory Failure.

Compliance with ethical standards

Conflicts of interest

IT received consulting fees from MBMed SA. LB’s research laboratory received research grants and/or equipment from Covidien, General Electric, Fisher Paykel, Maquet, Air Liquide, and Philips.

References

  1. 1.
    Brochard L, Slutsky A, Pesenti A (2017) Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 195:438–442.  https://doi.org/10.1164/rccm.201605-1081CP CrossRefPubMedGoogle Scholar
  2. 2.
    Goligher EC, Dres M, Fan E et al (2017) Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med.  https://doi.org/10.1164/rccm.201703-0536OC PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Tobin MJ, Gardner W (1998) Monitoring the control of breathing. In: Tobin M (ed) Principles and practice of intensive care monitoring. McGraw-Hill, New York, pp 415–464Google Scholar
  4. 4.
    Whitelaw WA, Derenne JP, Milic-Emili J (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 23:181–199.  https://doi.org/10.1016/0034-5687(75)90059-6 CrossRefPubMedGoogle Scholar
  5. 5.
    Alberti A, Gallo F, Fongaro A et al (1995) P 0.1 is a useful parameter in setting the level of pressure support ventilation. Intensive Care Med 21:547–553.  https://doi.org/10.1007/BF01700158 CrossRefPubMedGoogle Scholar
  6. 6.
    Mancebo J, Albaladejo P, Touchard D et al (2000) Airway occlusion pressure to titrate positive end-expiratory pressure in patients with dynamic hyperinflation. Anesthesiology 93:81–90.  https://doi.org/10.1097/00000542-200007000-00016 CrossRefPubMedGoogle Scholar
  7. 7.
    Holle RH, Schoene RB, Pavlin EJ (1984) Effect of respiratory muscle weakness on P 0.1 induced by partial curarization. J Appl Physiol 57:1150–1157.  https://doi.org/10.1152/jappl.1984.57.4.1150 CrossRefPubMedGoogle Scholar
  8. 8.
    Kera T, Aihara A, Inomata T (2013) Reliability of airway occlusion pressure as an index of respiratory motor output. Respir Care 58:845–849.  https://doi.org/10.4187/respcare.01717 PubMedCrossRefGoogle Scholar
  9. 9.
    Murciano D, Aubier M, Bussi S et al (1982) Comparison of esophageal, tracheal, and mouth occlusion pressure in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis 126:837–841.  https://doi.org/10.1164/arrd.1982.126.5.837 PubMedCrossRefGoogle Scholar
  10. 10.
    Conti G, Cinnella G, Barboni E et al (1996) Estimation of occlusion pressure during assisted ventilation in patients with intrinsic PEEP. Am J Respir Crit Care Med 154:907–912.  https://doi.org/10.1164/ajrccm.154.4.8887584 CrossRefPubMedGoogle Scholar
  11. 11.
    Telias IG, Junhasavasdikul D, Rittayamai N et al (2017) Accuracy of P 0.1 displayed by modern ventilators—a bench study. Am J Respir Crit Care Med 195:A1881Google Scholar
  12. 12.
    Rittayamai N, Beloncle F, Goligher EC et al (2017) Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort. Ann Intensive Care 7:100.  https://doi.org/10.1186/s13613-017-0324-z CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pletsch-Assuncao R, Caleffi Pereira M, Ferreira JG et al (2017) Accuracy of invasive and noninvasive parameters for diagnosing ventilatory overassistance during pressure support ventilation. Crit Care Med.  https://doi.org/10.1097/CCM.0000000000002871 CrossRefGoogle Scholar
  14. 14.
    Iotti GA, Brunner JX, Braschi A et al (1996) Closed-loop control of airway occlusion pressure at 0.1 second (P 0.1) applied to pressure-support ventilation: algorithm and application in intubated patients. Crit Care Med 24:771–779CrossRefPubMedGoogle Scholar
  15. 15.
    Mauri T, Grasselli G, Suriano G et al (2016) Control of respiratory drive and effort in extracorporeal membrane oxygenation patients recovering from severe acute respiratory distress syndrome. Anesthesiology 125:159–167.  https://doi.org/10.1097/ALN.0000000000001103 CrossRefPubMedGoogle Scholar
  16. 16.
    Bellani G, Foti G, Spagnolli E et al (2010) Increase of oxygen consumption during a progressive decrease of ventilatory support is lower in patients failing the trial in comparison with those who succeed. Anesthesiology 113:378–385.  https://doi.org/10.1097/ALN.0b013e3181e81050 CrossRefPubMedGoogle Scholar
  17. 17.
    Fernandez R, Raurich JM, Mut T et al (2004) Extubation failure: diagnostic value of occlusion pressure (P 0.1) and P 0.1-derived parameters. Intensive Care Med 30:234–240.  https://doi.org/10.1007/s00134-003-2070-y CrossRefPubMedGoogle Scholar
  18. 18.
    Sklar MC, Burns K, Rittayamai N et al (2017) Effort to breathe with various spontaneous breathing trial techniques. a physiologic meta-analysis. Am J Respir Crit Care Med 195:1477–1485.  https://doi.org/10.1164/rccm.201607-1338OC CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Irene Telias
    • 1
    • 2
    • 3
    • 4
  • Felipe Damiani
    • 1
    • 2
    • 5
  • Laurent Brochard
    • 1
    • 2
    Email author
  1. 1.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  2. 2.Keenan Research Centre, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  3. 3.Division of Respirology, Department of MedicineUniversity Health Network and Sinai Health SystemTorontoCanada
  4. 4.Sanatorio Mater DeiBuenos AiresArgentina
  5. 5.Departamento de Medicina IntensivaPontificia Universidad Católica de ChileSantiagoChile

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