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Master Thesis

Évaluation de la relation entre Pression Motrice en Ventilation Spontanée avec Aide Inspiratoire et durée de sevrage ventilatoire chez les patients de réanimation post-SDRA

Abstract : Evaluation of the relationship between driving pressure in Pressure Support Ventilation (PSV) and Mechanical Ventilation Weaning Time on post-ARDS patients in ICU Introduction: With the birth of Mechanical Ventilation in the 1950s came the ventilation induced lung injuries (VILI). Numerous works have since then shown the benefit of “protective ventilation”, notably by controlling the delivered tidal volume and pressures. However, as the respiratory condition improves and the weaning is started by shifting to Pressure Support Ventilation (PSV), these parameters stop being tightly controlled. This study aims to determine whether there is a relationship between the driving pressure measured in PSV and the weaning time. Material and methods: this is a prospective monocentric cohort study (CliniclTrials.gov, NCT04078984). Patients from the digestive, thoracic and medical intensive care units of the Bordeaux University Hospital with moderate to severe ARDS were evaluated. They were included when they started the ventilatory weaning phase, defined as the transition from Volume Assist-Control Ventilation (VAC) to active ventilation by PSV. Driving pressure (ΔP) was measured daily by an endinspiratory occlusion maneuver. Two groups were then formed according to whether ΔP < 14 cmH2O or ΔP ≥ 14 cmH2O. The primary endpoint was the Ventilator Free Days at day 28 of the switch to PSV. The ΔP measuring method was validated by comparing the respiratory system compliances (Crs) - values calculated from ΔP - in VAC and PSV. Results: 37 patients were included from September 2019 to May 2020. Retrospective data from seven patients who were used to assess the feasibility of the study were also analyzed, forming a total cohort of 44 patients. 20 patients (45%) had a ΔP ≥ 14 cmH2O. Patients were comparable in both groups at inclusion. VFD was 22 days [8-25] in the ΔP < 14 cmH2O group and 18 days [5-26] in the ΔP ≥ 14 cmH2O group (estimated absolute difference - 0 days; IC95 -3 to 6; p = 0.78). The probability of extubation without re-intubation at D28 estimated by the Kaplan-Meier method was not different between the two groups (83%, IC95(74; 89) vs. 75% IC95(61; 85)). The correlation by linear regression between Crs in VAC and Crs in PSV was moderate (R²=0.28). Conclusion: in post-ARDS patients initiating ventilatory weaning, a ΔP ≥ 14 cmH2O was not associated with a lower number of days without invasive ventilation at D28. End-inspiratory occlusion maneuver is a simple yet reasonably accurate method for estimating pressures and compliances in VSAI.
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https://dumas.ccsd.cnrs.fr/dumas-03012150
Contributor : Médecine Ub <>
Submitted on : Wednesday, November 18, 2020 - 2:02:49 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
Long-term archiving on: : Friday, February 19, 2021 - 7:40:41 PM

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  • HAL Id : dumas-03012150, version 1

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Jean de Montaudouin. Évaluation de la relation entre Pression Motrice en Ventilation Spontanée avec Aide Inspiratoire et durée de sevrage ventilatoire chez les patients de réanimation post-SDRA. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03012150⟩

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