Airway Occlusion Pressure As an Estimate of Respiratory Drive and Inspiratory Effort during Assisted Ventilation

Abstract

Rationale Monitoring and controlling respiratory drive and effort may help to minimize lung and diaphragm injury. Airway occlusion pressure (P0.1) is a non-invasive measure of respiratory drive. Objectives To determine: (1) the validity of ‘ventilator’ P0.1 displayed on the screen (P0.1vent) as a measure of drive, (2) the ability of P0.1 to detect potentially injurious levels of effort, and (3) how P0.1vent displayed by different ventilators compares to a ‘reference’ P0.1 measured from airway pressure recording during an occlusion (P0.1ref). Methods, measurements Analysis of three studies in patients, one in healthy subjects under assisted ventilation, and a bench study with six ventilators. P0.1vent was validated against measures of drive (electrical activity of the diaphragm and muscular pressure over time) and P0.1ref. Performance of P0.1ref and P0.1vent to detect pre-defined potentially injurious effort was tested using derivation and validation datasets using esophageal pressure-time product as the reference standard. Results P0.1vent correlated well with measures of drive and with esophageal pressure-time product (within-subjects R²=0.8). P0.1ref >3.5 cmH2O was 80% sensitive and 77% specific for detecting high effort (≥ 200 cmH₂O·sec·min^-1); P0.1ref 2O·sec·min^-1). Area under Receiver-Operating-Characteristic Curves for P0.1vent to detect potentially high and low effort were 0.81 and 0.92. Bench experiments showed a low mean bias for P0.1vent compared to P0.1ref for most ventilators but precision varied; in patients, precision was lower. Ventilators estimating P0.1vent without occlusions could underestimate P0.1ref. Conclusion P0.1 is a reliable bedside tool to assess respiratory drive and detect potentially injurious inspiratory effort.