Expiratory flow limitation during mechanical ventilation : real‑time detection and physiological subtypes.

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Autor(es): dc.creatorJunhasavasdikul, Detajin-
Autor(es): dc.creatorKasemchaiyanun, Akarawut-
Autor(es): dc.creatorTassaneyasin, Tanakorn-
Autor(es): dc.creatorPetnak, Tananchai-
Autor(es): dc.creatorBezerra, Frank Silva-
Autor(es): dc.creatorMellado Artigas, Ricard-
Autor(es): dc.creatorChen, Lu-
Autor(es): dc.creatorSutherasan, Yuda-
Autor(es): dc.creatorTheerawit, Pongdhep-
Autor(es): dc.creatorBrochard, Laurent Jean-
Data de aceite: dc.date.accessioned2025-08-21T15:47:35Z-
Data de disponibilização: dc.date.available2025-08-21T15:47:35Z-
Data de envio: dc.date.issued2025-03-07-
Data de envio: dc.date.issued2023-
Fonte completa do material: dc.identifierhttps://www.repositorio.ufop.br/handle/123456789/19856-
Fonte completa do material: dc.identifierhttps://doi.org/10.1186/s13054-024-04953-9-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/capes/1024203-
Descrição: dc.descriptionBackground: Tidal expiratory flow limitation ( EFLT) complicates the delivery of mechanical ventilation but is only diagnosed by performing specific manoeuvres. Instantaneous analysis of expiratory resistance (Rex) can be an alternative way to detect EFLT without changing ventilatory settings. This study aimed to determine the agreement of EFLT detection by Rex analysis and the PEEP reduction manoeuvre using contingency table and agreement coefficient. The patterns of Rex were explored. Methods: Medical patients ≥ 15-year-old receiving mechanical ventilation underwent a PEEP reduction manoeuvre from 5 cmH2O to zero for EFLT detection. Waveforms were recorded and analyzed off-line. The instantaneous Rex was calculated and was plotted against the volume axis, overlapped by the flow-volume loop for inspection. Lung mechanics, characteristics of the patients, and clinical outcomes were collected. The result of the Rex method was validated using a separate independent dataset. Results: 339 patients initially enrolled and underwent a PEEP reduction. The prevalence of EFLT was 16.5%. EFLT patients had higher adjusted hospital mortality than non-EFLT cases. The Rex method showed 20% prevalence of EFLT and the result was 90.3% in agreement with PEEP reduction manoeuvre. In the validation dataset, the Rex method had resulted in 91.4% agreement. Three patterns of Rex were identified: no EFLT, early EFLT, associated with airway disease, and late EFLT, associated with non-airway diseases, including obesity. In early EFLT, external PEEP was less likely to eliminate EFLT. Conclusions: The Rex method shows an excellent agreement with the PEEP reduction manoeuvre and allows realtime detection of EFLT. Two subtypes of EFLT are identified by Rex analysis.-
Formato: dc.formatapplication/pdf-
Idioma: dc.languageen-
Direitos: dc.rightsrestrito-
Direitos: dc.rightsThis article is under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Fonte: PDF do artigo.-
Palavras-chave: dc.subjectMechanical ventilation-
Palavras-chave: dc.subjectPositive-pressure respiration-
Palavras-chave: dc.subjectRespiratory mechanics-
Palavras-chave: dc.subjectChronic airflow obstruction-
Palavras-chave: dc.subjectObesity-
Título: dc.titleExpiratory flow limitation during mechanical ventilation : real‑time detection and physiological subtypes.-
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