Sedation-Ventilation Interaction in Acute Hypoxemic Respiratory Failure: Secondary Analysis of the LANDMARK Trial
CHEST Critical Care（2024）
Interdepartmental Division of Critical Care Medicine
Abstract
BackgroundVentilation and sedation are used for the management of acute hypoxemic respiratory failure (AHRF), but their optimal combination to minimize the risks of ventilation is not well understood.Research questionWhat are the individual effects and interactions of inspiratory and end-expiratory pressure (PEEP), sedation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on respiratory drive, effort, and lung-distending pressure in patients with AHRF triggering the ventilator?Study designand methods: Secondary exploratory analysis of a trial of lung and diaphragm protection in AHRF. Inspiratory pressure, sedation, PEEP, and VV-ECMO were titrated while respiratory drive (airway pressure in the first 100 milliseconds, P0.1), effort (esophageal pressure swing, |ΔPes|), and lung-distending pressure (dynamic transpulmonary driving pressure, ΔPL,dyn) were recorded. Associations were evaluated using linear mixed effects regression models including pre-specified terms for potential interactions.ResultsThe study included 223 individual measurements of P0.1 and 235 individual measurements of |ΔPes| and ΔPL,dyn from 30 patients. Propofol attenuated P0.1 (–0.4 cm H2O, 95% CI –0.3, –0.1 per 10 mcg/kg/min increase), |ΔPes| (–2.5 cm H2O, 95% CI –3.4, –1.7 per 10 mcg/kg/min increase) and ΔPL,dyn (–1.6 cm H2O, 95% CI –2.3, –0.8 per 10 mcg/kg/min increase). The effect of inspiratory pressure on |ΔPes| varied depending on propofol dose: with higher propofol dose, inspiratory pressure resulted in higher ΔPL,dyn. Under VV-ECMO, patients (n=16) had significantly lower |ΔPes| (–10 cm H2O, 95% CI –17.5, –2.5) and required less sedation to reduce |ΔPes| than without VV-ECMO (n=14).InterpretationMechanical ventilation, sedation, and VV-ECMO exert interdependent effects on respiratory drive, effort, and lung-distending pressure in AHRF. Patients under VV-ECMO require less sedation to control respiratory effort.
MoreTranslated text
Key words
list: Acute hypoxemic respiratory failure,Lung and diaphragm protective ventilation,Mechanical ventilation,Respiratory effort,VV-ECMO
求助PDF
上传PDF
View via Publisher
AI Read Science
AI Summary
AI Summary is the key point extracted automatically understanding the full text of the paper, including the background, methods, results, conclusions, icons and other key content, so that you can get the outline of the paper at a glance.
Example
Background
Key content
Introduction
Methods
Results
Related work
Fund
Key content
- Pretraining has recently greatly promoted the development of natural language processing (NLP)
- We show that M6 outperforms the baselines in multimodal downstream tasks, and the large M6 with 10 parameters can reach a better performance
- We propose a method called M6 that is able to process information of multiple modalities and perform both single-modal and cross-modal understanding and generation
- The model is scaled to large model with 10 billion parameters with sophisticated deployment, and the 10 -parameter M6-large is the largest pretrained model in Chinese
- Experimental results show that our proposed M6 outperforms the baseline in a number of downstream tasks concerning both single modality and multiple modalities We will continue the pretraining of extremely large models by increasing data to explore the limit of its performance
Upload PDF to Generate Summary
Must-Reading Tree
Example
Generate MRT to find the research sequence of this paper
Data Disclaimer
The page data are from open Internet sources, cooperative publishers and automatic analysis results through AI technology. We do not make any commitments and guarantees for the validity, accuracy, correctness, reliability, completeness and timeliness of the page data. If you have any questions, please contact us by email: report@aminer.cn
Chat Paper