We have published this year at the ISICEM an abstract about mechanical power 1 and its reduction during extracorporeal CO2 removal. We have found that the optimal combination of tidal volume and frequency might be different than currently proposed strategies 2.
We show that an increase in needed ventilation due to a higher VCO2 is best met with an increase in respiratory rate, while higher tidal volumes might be beneficial in overcoming fixed dead space fractions. The optimal ventilation strategy ultimately depends on an optimized combination of RR, Vt and PEEP in the context of a given VD and shunt and could further reduce mechanical power below a critical VILI threshold, which has been shown to be at 12 J/min in piglets 3, but remains unknown for humans.
https://isicem.houlahop.com/category/C3_0/posters/P090
The abstract, published in the critical care supplement 2020 4, is online with audio commentary. https://isicem.houlahop.com/category/C3_0/posters/P090
References
- 1.Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575. doi:10.1007/s00134-016-4505-2
- 2.Combes A, Fanelli V, Pham T, Ranieri VM. Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study. Intensive Care Med. Published online February 21, 2019:592-600. doi:10.1007/s00134-019-05567-4
- 3.Cressoni M, Gotti M, Chiurazzi C, et al. Mechanical Power and Development of Ventilator-induced Lung Injury. Anesthesiology. Published online May 1, 2016:1100-1108. doi:10.1097/aln.0000000000001056
- 4.40th International Symposium on Intensive Care & Emergency Medicine. Crit Care. Published online March 2020. doi:10.1186/s13054-020-2772-3
Photo by Immo Wegmann on Unsplash
No Comment Yet