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Mechanical power at a glance: a simple surrogate for volume-controlled ventilation
Intensive Care Medicine Experimental Pub Date : 2019-11-27 , DOI: 10.1186/s40635-019-0276-8
Lorenzo Giosa 1 , Mattia Busana 1 , Iacopo Pasticci 1 , Matteo Bonifazi 1 , Matteo Maria Macrì 1 , Federica Romitti 1 , Francesco Vassalli 1 , Davide Chiumello 2, 3 , Michael Quintel 1 , J J Marini 4 , Luciano Gattinoni 1
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AbstractBackgroundMechanical power is a summary variable including all the components which can possibly cause VILI (pressures, volume, flow, respiratory rate). Since the complexity of its mathematical computation is one of the major factors that delay its clinical use, we propose here a simple and easy to remember equation to estimate mechanical power under volume-controlled ventilation: Mechanical Power=VE×Peak Pressure+PEEP+F/620$$ \mathrm{Mechanical}\ \mathrm{Power}=\frac{\mathrm{VE}\times \left(\mathrm{Peak}\ \mathrm{Pressure}+\mathrm{PEEP}+F/6\right)}{20} $$where the mechanical power is expressed in Joules/minute, the minute ventilation (VE) in liters/minute, the inspiratory flow (F) in liters/minute, and peak pressure and positive end-expiratory pressure (PEEP) in centimeter of water. All the components of this equation are continuously displayed by any ventilator under volume-controlled ventilation without the need for clinician intervention.To test the accuracy of this new equation, we compared it with the reference formula of mechanical power that we proposed for volume-controlled ventilation in the past. The comparisons were made in a cohort of mechanically ventilated pigs (485 observations) and in a cohort of ICU patients (265 observations).ResultsBoth in pigs and in ICU patients, the correlation between our equation and the reference one was close to the identity. Indeed, the R2 ranged from 0.97 to 0.99 and the Bland-Altman showed small biases (ranging from + 0.35 to − 0.53 J/min) and proportional errors (ranging from + 0.02 to − 0.05).ConclusionsOur new equation of mechanical power for volume-controlled ventilation represents a simple and accurate alternative to the more complex ones available to date. This equation does not need any clinical intervention on the ventilator (such as an inspiratory hold) and could be easily implemented in the software of any ventilator in volume-controlled mode. This would allow the clinician to have an estimation of mechanical power at a simple glance and thus increase the clinical consciousness of this variable which is still far from being used at the bedside. Our equation carries the same limitations of all other formulas of mechanical power, the most important of which, as far as it concerns VILI prevention, are the lack of normalization and its application to the whole respiratory system (including the chest wall) and not only to the lung parenchyma.

中文翻译:

机械功率一览:容量控制通气的简单替代品

AbstractBackgroundMechanical power 是一个汇总变量,包括所有可能导致 VILI(压力、体积、流量、呼吸频率)的成分。由于其数学计算的复杂性是延迟其临床使用的主要因素之一,我们在此提出一个简单易记的公式来估计容量控制通气下的机械功率:机械功率=VE×峰值压力+PEEP+F /620$$ \mathrm{机械}\ \mathrm{Power}=\frac{\mathrm{VE}\times \left(\mathrm{Peak}\ \mathrm{Pressure}+\mathrm{PEEP}+F/6 \right)}{20} $$ 其中机械功率以焦耳/分钟表示,分钟通气量 (VE) 以升/分钟表示,吸气流量 (F) 以升/分钟表示,以及峰值压力和呼气末正压厘米水压 (PEEP)。该方程的所有分量在容量控制通气下由任何呼吸机连续显示,无需临床医生干预。为了测试这个新方程的准确性,我们将其与我们提出的容量控制机械功率参考公式进行了比较过去通风。在一组机械通气猪(485 次观察)和一组 ICU 患者(265 次观察)中进行了比较。结果在猪和 ICU 患者中,我们的方程与参考方程之间的相关性接近一致。实际上,R2 的范围为 0.97 到 0.99,并且 Bland-Altman 显示出小的偏差(范围从 + 0.35 到 - 0.53 J/min)和比例误差(范围从 + 0.02 到 - 0.05)。结论我们用于容量控制通气的新机械功率方程代表了一种简单而准确的替代方法,可以替代目前可用的更复杂的方法。该方程不需要对呼吸机进行任何临床干预(例如吸气保持),并且可以在容量控制模式下的任何呼吸机的软件中轻松实现。这将允许临床医生一目了然地估计机械功率,从而增加对这个变量的临床意识,该变量仍然远未在床边使用。我们的公式与所有其他机械功率公式具有相同的局限性,其中最重要的是,就预防 VILI 而言,
更新日期:2019-11-27
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