A systematic approach to adjusting ventilation and sedation combined with partial neuromuscular blockade can achieve lung and diaphragm protection in most patients with acute hypoxemic respiratory failure, according to a study published in Crit_Care.
]. We conducted a physiological trial in patients with early AHRF to establish whether LDP targets could be achieved by systematically titrating inspiratory pressure, sedation, positive end-expiratory pressure and, in patients already on veno-venous extracorporeal membrane oxygenation , sweep gas flow. In patients refractory to these interventions, we evaluated whether LDP targets could be achieved by applying adjunctive partial neuromuscular blockade.
Transpulmonary pressure was computed by real-time subtraction of Pes from Paw. Static airway driving pressure and transpulmonary driving pressure were measured by applying a transient end-inspiratory hold and a transient end-expiratory hold on the ventilator to measure plateau airway pressure plateau esophageal pressure , total PEEP , and end-expiratory esophageal pressure , respectively. ∆Pes was computed as the difference between end-expiratory Pes and the nadir of inspiratory Pes.
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