Consistency Between Safe Mechanical Ventilation Parameters in the General ICU Patient Population

While ventilation with the guidance of plateau airway pressure is essential part of lung protective ventilation other physiologic monitoring tools like driving pressure (DP), transpulmonary pressure (PL) and mechanical power (MP) are also investigating for this aim. The majority of data regarding these parameters come from patients with ARDS. However, VILI is not just a problem in patients with ARDS but in all critically ill patients receiving mechanical ventilation. The aim of the study was to investigate the safety thresholds' of physiologic parameters consistency each other for safe mechanical ventilation (MV) in ICU patients. Patients and methods Thirty-four patients who have paranchimal, pleural, airflow limitation, chest wall problems were included in the study. Inspiratory and expiratory airway and eosephageal pressures were measured. Esophageal pressure (Pes) was measured with the AVEA SmartCath Esophageal Pressure Monitoring Tube Set; 8Fr-adult. PL, DP and MP of the patients were computed. Results The main reasons for respiratory failure were pneumonia (71%) and COPD (56%). Mean BMI was 30 + 11 kg/m2. When we try to understand how many of our patients were receiving safe MV according to Pplat<30 cmH2O and 27 cmH2O thresholds, 97% and 75% of them were receiving safe MV respectively. When Pplat>30 cm2 accepted as gold standard only PL inspiratory>25 cmH2O had significant and high diagnostic values. When Pplat>27 cmH2O is accepted as gold standard DP > 15, 19 cmH2O and PLi > 20 cm H2O had significant and high diagnostic value. Combination of parameters did not increase diagnostic values and consistency. Conclusion Results of our study suggest that rate of receiving safe MV according to recommended thresolds are not consistent closely each other particularly for higher threshold values and when safety limits are decreased consistency between the parameters increased.