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Master Thesis

Mécanique respiratoire, stress pulmonaire et strain statique durant 3 protocoles de titration de la PEEP au lit du malade en SDRA

Abstract : Purpose: to assess respiratory mechanics and derived indices as airway (DPA) and transpulmonary driving pressure (DPTP), levels of stress and static strain during three validated protocols of positive end expiratory pressure (PEEP) titration in ARDS. Methods: prospective data collection in adult patients with moderate to severe ARDS under mechanical ventilation. Systematic measurement of oesophageal pressure (Pes) was used to estimate transpulmonary pressure. All sedated and curarized patients benefited from three methods of PEEP titration, alternatively based on inspiratory transpulmonary pressure (Ptpi group), expiratory transpulmonary pressure (Ptpe group) or airway inspiratory plateau pressure (Express group). End expiratory lung volume (EELV) measurements were used to calculate static strain. Comparison between DPA, DPTP, lung stress and static strain were made. Results: eighteen patients were included in 2016. There was a high correlation between DPA and DPTP in all protocols (r2 from 0.870 to 0.972). Lung stress was higher when DPA exceeded 15 cmH2O (p < 0.001) but not static strain (p = 0.834). Lung stress, static strain, DPA and DPTP were higher in Ptpi group. Relative transpulmonary pressure was higher than absolute transpulmonary pressure. Conclusions: our results tend to indicate the feasibility of regular Pes monitoring to guide bedside PEEP titration in patients with moderate to severe ARDS. Derived indices of Pes and EELV measurements suggest an increase in alveolar damage in Ptpi group. The difference between relative and absolute transpulmonary pressure may change PEEP titration and reduce Ptpi target. Complementary randomized trials are required to determine which strategy may limit lung stress, static strain and driving pressure, thus possibly improving clinical outcome.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01611800
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, October 6, 2017 - 12:32:54 PM
Last modification on : Tuesday, October 17, 2017 - 1:12:00 AM
Long-term archiving on: : Monday, January 8, 2018 - 2:45:37 PM

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Marie Bergez. Mécanique respiratoire, stress pulmonaire et strain statique durant 3 protocoles de titration de la PEEP au lit du malade en SDRA. Médecine humaine et pathologie. 2017. ⟨dumas-01611800⟩

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