Particle flow rate from the airways as fingerprint diagnostics in mechanical ventilation in the intensive care unit: a randomised controlled study
- Filip Hallgren1,
- Martin Stenlo2,3,4,5,
- Anna Niroomand3,4,5,6,
- Ellen Broberg2,3,4,5,
- Snejana Hyllén2,3,4,5,
- Malin Malmsjö4 and
- Sandra Lindstedt1,3,4,5⇑
- 1Dept. of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- 2Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
- 3Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- 4Dept. of Clinical Sciences, Lund University, Lund, Sweden
- 5Lund Stem Cell Center, Lund University, Lund, Sweden
- 6Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Sandra Lindstedt (sandra.lindstedt_ingemansson{at}med.lu.se)
Abstract
Introduction Mechanical ventilation (MV) 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 MV 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 (RM). 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 MV 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.
Footnotes
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Conflict of interest: Dr. Hallgren has nothing to disclose.
Conflict of interest: Dr. Stenlo has nothing to disclose.
Conflict of interest: Dr. Niroomand has nothing to disclose.
Conflict of interest: Dr. Brober has nothing to disclose.
Conflict of interest: Dr. Hyllen has nothing to disclose.
Conflict of interest: Dr. Malmsjö has nothing to disclose.
Conflict of interest: Dr. Lindstedt has nothing to disclose.
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- Received December 21, 2020.
- Accepted May 23, 2021.
- Copyright ©The authors 2021
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