Prevalence of Complete Airway Closure According to Body Mass Index in Acute Respiratory Distress Syndrome Pooled Cohort Analysis

ConclusionsPrevalence of complete airway closure was high in ARDS and should be taken into account when calculating respiratory mechanics, especially in the most morbidly obese patients.Editor ’s PerspectiveWhat We Already Know about This TopicPlateau and driving pressures have been shown to correlate with mortality in adult respiratory distress syndrome (ARDS). However, these static airway pressures may not always accurately reflect alveolar pressure.It has recently been recognized that in ARDS, airway closure may occur while some alveoli are still inflated. This may result in a biased estimate of mean alveolar pressure.Complete airway closure can only be measured by the inflection point on the initial portion of a low-flow inflation pressure –volume or pressure–time curve with the absence of cardiac oscillations and very low compliance, most likely in the terminal bronchioles.In 25 to 33% of patients with ARDS, airway opening pressure (the inflection point value) is greater than the total positive end-expiratory pressure measured by an end-expiratory maneuver.What This Article Tells Us That Is NewIn apost hoc analysis of two cohort studies of respiratory mechanics in ARDS, the authors compared the prevalence of complete airway closure stratified by body mass index and its effects on respiratory mechanics.Complete airway closure was present in 41% of patients, increasing with body mass index tercile (65% in the highest).Driving pressure and respiratory system elastance...
Source: Anesthesiology - Category: Anesthesiology Source Type: research