Imprecision in lower 'inflection point' estimation from static pressure- volume curves in patients at risk for acute respiratory distress syndrome

Grant E. O'Keefe, Larry M. Gentilello, Shelly Erford, Ronald V. Maier

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower 'inflection point' (P(flex)) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower P(flex) from these curves. Methods: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower P(flex) from these curves. Results: P(flex) estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. Conclusion: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.

Original languageEnglish (US)
Pages (from-to)1065-1068
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume44
Issue number6
StatePublished - 1998

Fingerprint

Adult Respiratory Distress Syndrome
Positive-Pressure Respiration
Physicians
Pressure

Keywords

  • ARDS
  • Mechanical ventilation
  • Respiratory failure

ASJC Scopus subject areas

  • Surgery

Cite this

@article{483d619b058440a0806ee4300837df7f,
title = "Imprecision in lower 'inflection point' estimation from static pressure- volume curves in patients at risk for acute respiratory distress syndrome",
abstract = "Background: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower 'inflection point' (P(flex)) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower P(flex) from these curves. Methods: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower P(flex) from these curves. Results: P(flex) estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. Conclusion: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.",
keywords = "ARDS, Mechanical ventilation, Respiratory failure",
author = "O'Keefe, {Grant E.} and Gentilello, {Larry M.} and Shelly Erford and Maier, {Ronald V.}",
year = "1998",
language = "English (US)",
volume = "44",
pages = "1065--1068",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Imprecision in lower 'inflection point' estimation from static pressure- volume curves in patients at risk for acute respiratory distress syndrome

AU - O'Keefe, Grant E.

AU - Gentilello, Larry M.

AU - Erford, Shelly

AU - Maier, Ronald V.

PY - 1998

Y1 - 1998

N2 - Background: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower 'inflection point' (P(flex)) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower P(flex) from these curves. Methods: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower P(flex) from these curves. Results: P(flex) estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. Conclusion: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.

AB - Background: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower 'inflection point' (P(flex)) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower P(flex) from these curves. Methods: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower P(flex) from these curves. Results: P(flex) estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. Conclusion: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.

KW - ARDS

KW - Mechanical ventilation

KW - Respiratory failure

UR - http://www.scopus.com/inward/record.url?scp=66949174349&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66949174349&partnerID=8YFLogxK

M3 - Article

VL - 44

SP - 1065

EP - 1068

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -