Expiratory flow limitation in intensive care: prevalence and risk factors
Open Access
- 5 December 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 23 (1), 1-10
- https://doi.org/10.1186/s13054-019-2682-4
Abstract
Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL. Patients admitted to the intensive care unit (ICU) with an expected length of mechanical ventilation of 72 h were enrolled in this prospective, observational study. Patients were evaluated, within 24 h from ICU admission and for at least 72 h, in terms of respiratory mechanics, presence of EFL through the PEEP test, daily fluid balance and followed for outcome measurements. Among the 121 patients enrolled, 37 (31%) exhibited EFL upon admission. Flow-limited patients had higher BMI, history of pulmonary or heart disease, worse respiratory dyspnoea score, higher intrinsic positive end-expiratory pressure, flow and additional resistance. Over the course of the initial 72 h of mechanical ventilation, additional 21 patients (17%) developed EFL. New onset EFL was associated with a more positive cumulative fluid balance at day 3 (103.3 ml/kg) compared to that of patients without EFL (65.8 ml/kg). Flow-limited patients had longer duration of mechanical ventilation, longer ICU length of stay and higher in-ICU mortality. EFL is common among ICU patients and correlates with adverse outcomes. The major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. Further studies are needed to assess if a restrictive fluid therapy might be associated with a lower incidence of EFL.Keywords
This publication has 38 references indexed in Scilit:
- Pulmonary Function and Expiratory Flow Limitation in Acute Cervical Spinal Cord InjuryArchives of Physical Medicine and Rehabilitation, 2012
- Fluid balance in critically ill children with acute lung injury*Critical Care Medicine, 2012
- Expiratory Flow LimitationComprehensive Physiology, 2011
- Orthopnea and Tidal Expiratory Flow Limitation in Chronic Heart FailureSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2006
- Comparison of Two Fluid-Management Strategies in Acute Lung InjuryThe New England Journal of Medicine, 2006
- High Tidal Volume and Positive Fluid Balance Are Associated With Worse Outcome in Acute Lung InjurySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patientsActa Anaesthesiologica Scandinavica, 2004
- Effects of positive end-expiratory pressure on gas exchange and expiratory flow limitation in adult respiratory distress syndrome*Critical Care Medicine, 2002
- Tidal expiratory flow limitation and chronic dyspnoea in patients with cystic fibrosisEuropean Respiratory Journal, 2002
- Evaluation of Clinical Methods for Rating DyspneaSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1988