Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure
Bibliographic record
Abstract
RATIONALE: Excessive stress (distending pressure), strain (volume deformation), and drop in inspiratory alveolar pressure are proposed mechanisms for patient self-inflicted lung injury. OBJECTIVES: To dissect the influence of inspiratory effort, respiratory mechanics, and ventilation mode on lung stress, strain, and drop in inspiratory alveolar pressure and to explore their impact on oxygenation and lung compliance. METHODS: An international cohort study was conducted analyzing respiratory recordings (esophageal pressure) from patients with acute hypoxemic respiratory failure. Association between muscular pressure (Pmus), surrogates of stress (driving transalveolar pressure), strain (Vt), and inspiratory alveolar pressure relative to positive end-expiratory pressure (PEEP) were explored using mixed models, including interactions for ventilation mode, respiratory system elastance, and synchrony. Association between these and changes in oxygenation and lung compliance were explored. MEASUREMENTS AND MAIN RESULTS: Sixty patients from 15 centers represented 528 recordings (339,796 breaths). For each 1 cm H2O increase in Pmus, there were increases in driving transalveolar pressure (median [95% confidence interval (CI)], 0.28 [0.27 to 0.29] cm H2O) and Vt (median [95% CI], 0.16 [0.16 to 0.17] ml/kg of predicted body weight) and a decrease in alveolar pressure (median [95% CI], 0.25 [0.24 to 0.6] cm H2O; P < 0.001). Volume-control ventilation showed lesser increases in stress and strain surrogates than pressure-targeted modes but more drop in alveolar pressure (P < 0.001; Pmus-by-mode interaction). Breath stacking was infrequent and was associated with higher stress. Lower inspiratory alveolar pressure relative to PEEP was associated with subsequent worsening oxygenation (P = 0.04) and higher stress with worsening lung compliance (P = 0.023). CONCLUSIONS: Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, and are associated with subsequent worsening oxygenation and lung compliance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".