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. 2023 Jun 5;13(11):1965.
doi: 10.3390/diagnostics13111965.

Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing

Sergio Lassola  1 , Sara Miori  1 , Andrea Sanna  1 , Ilaria Menegoni  1 , Silvia De Rosa  1   2 , Giacomo Bellani  1   2 , Michele Umbrello  3
Affiliations

Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing

Sergio Lassola et al. Diagnostics (Basel). .

Abstract

Introduction: The clinical features of COVID-19 are highly variable. It has been speculated that the progression across COVID-19 may be triggered by excessive inspiratory drive activation. The aim of the present study was to assess whether the tidal swing in central venous pressure (ΔCVP) is a reliable estimate of inspiratory effort.

Methods: Thirty critically ill patients with COVID-19 ARDS underwent a PEEP trial (0-5-10 cmH2O) during helmet CPAP. Esophageal (ΔPes) and transdiaphragmatic (ΔPdi) pressure swings were measured as indices of inspiratory effort. ΔCVP was assessed via a standard venous catheter. A low and a high inspiratory effort were defined as ΔPes ≤ 10 and >15 cmH2O, respectively.

Results: During the PEEP trial, no significant changes in ΔPes (11 [6-16] vs. 11 [7-15] vs. 12 [8-16] cmH2O, p = 0.652) and in ΔCVP (12 [7-17] vs. 11.5 [7-16] vs. 11.5 [8-15] cmH2O, p = 0.918) were detected. ΔCVP was significantly associated with ΔPes (marginal R2 0.87, p < 0.001). ΔCVP recognized both low (AUC-ROC curve 0.89 [0.84-0.96]) and high inspiratory efforts (AUC-ROC curve 0.98 [0.96-1]).

Conclusions: ΔCVP is an easily available a reliable surrogate of ΔPes and can detect a low or a high inspiratory effort. This study provides a useful bedside tool to monitor the inspiratory effort of spontaneously breathing COVID-19 patients.

Keywords: ARDS; COVID-19; central venous pressure; esophageal pressure; inspiratory effort.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Relationship between central venous pressure swing and esophageal pressure swing during the different phases of the study. Each color represents a patient; the dots, connected by a line, represent the three measures at different PEEP levels. The solid lines represent the linear predictions, while the grey area is their 95% confidence interval. Analysis was performed for all patients using a mixed model for repeated measures to account for the longitudinal structure of our data set (patients with repeated measurements over time).
Figure 2
Figure 2
Correlation of central venous pressure swing and esophageal pressure swing during the different phases of the study. The solid lines represent the linear predictions, while the gray area is their 95% confidence interval. The analysis was performed by linear regression. (a) ZEEP. (b) PEEP 5. (c) PEEP 10.
Figure 3
Figure 3
Diagnostic performance of the central venous pressure swing to detect low inspiratory effort (right panel) and high inspiratory effort (left panel), defined as an esophageal pressure swing ≤ 10 and >15 cmH2O, respectively. The best cut-off for detecting a low inspiratory effort was 11 cmH2O, while the best cut-off for detecting a high inspiratory effort was 15 cmH2O.
See this image and copyright information in PMC

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