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Expiratory flow limitation in intensive care: prevalence and risk factors
Critical Care ( IF 15.1 ) Pub Date : 2019-12-01 , DOI: 10.1186/s13054-019-2682-4
Carlo Alberto Volta 1 , Francesca Dalla Corte 1 , Riccardo Ragazzi 1 , Elisabetta Marangoni 1 , Alberto Fogagnolo 1 , Gaetano Scaramuzzo 1 , Domenico Luca Grieco 2 , Valentina Alvisi 1 , Chiara Rizzuto 1, 3 , Savino Spadaro 1
Affiliation  

BackgroundExpiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL.MethodsPatients admitted to the intensive care unit (ICU) with an expected length of mechanical ventilation of 72 h were enrolled in this prospective, observational study. Patients were evaluated, within 24 h from ICU admission and for at least 72 h, in terms of respiratory mechanics, presence of EFL through the PEEP test, daily fluid balance and followed for outcome measurements.ResultsAmong the 121 patients enrolled, 37 (31%) exhibited EFL upon admission. Flow-limited patients had higher BMI, history of pulmonary or heart disease, worse respiratory dyspnoea score, higher intrinsic positive end-expiratory pressure, flow and additional resistance. Over the course of the initial 72 h of mechanical ventilation, additional 21 patients (17%) developed EFL. New onset EFL was associated with a more positive cumulative fluid balance at day 3 (103.3 ml/kg) compared to that of patients without EFL (65.8 ml/kg). Flow-limited patients had longer duration of mechanical ventilation, longer ICU length of stay and higher in-ICU mortality.ConclusionsEFL is common among ICU patients and correlates with adverse outcomes. The major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. Further studies are needed to assess if a restrictive fluid therapy might be associated with a lower incidence of EFL.

中文翻译:

重症监护中呼气流量受限:患病率和风险因素

背景呼气流量限制 (EFL) 的特点是呼气流量显着减少,对呼气驱动压力不敏感。EFL的存在会影响呼吸和心血管功能,损害小气道;它的发生已在不同的疾病中得到证实,例如 COPD、哮喘、肥胖、心力衰竭、ARDS 和囊性纤维化。我们的目的是评估因急性呼吸衰竭需要机械通气的患者中 EFL 的患病率,并确定与 EFL 存在相关的主要临床特征、危险因素和临床结果。这项前瞻性观察性研究纳入了预期的 72 小时机械通气时间。对患者进行评估,在 ICU 入住后 24 小时内和至少 72 小时内,在呼吸力学、PEEP 测试中存在 EFL、每日体液平衡和随访结果测量方面。结果 在入组的 121 名患者中,37 名 (31%) 出现 EFL录取。流量受限的患者具有较高的 BMI、肺病或心脏病史、呼吸困难评分更差、内在呼气末正压、流量和额外阻力较高。在最初 72 小时的机械通气过程中,另外 21 名患者 (17%) 出现了 EFL。与没有 EFL 的患者(65.8 ml/kg)相比,新发作的 EFL 与第 3 天的累积液体平衡(103.3 ml/kg)更积极相关。流量受限的患者机械通气时间更长,ICU 住院时间更长,ICU 死亡率更高。结论 EFL 在 ICU 患者中很常见,并且与不良结局相关。在患者入住 ICU 的前 3 天期间发生 EFL 的主要决定因素是液体正平衡。需要进一步的研究来评估限制性液体疗法是否可能与较低的 EFL 发生率相关。
更新日期:2019-12-01
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