Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2018; 7(1): 24-30
Published online Feb 4, 2018. doi: 10.5492/wjccm.v7.i1.24
Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit
Kelser de Souza Kock, Rosemeri Maurici
Kelser de Souza Kock, Department of Physiotherapy, University of South of Santa Catarina, Tubarão, SC 88704-001, Brazil
Rosemeri Maurici, Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC 88700-000, Brazil
Author contributions: Kock KS performed the data collect, statistical analysis and wrote the mansucript; Maurici R performed the revision and editing the manuscript.
Conflict-of-interest statement: There is no conflict-of-interest.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kelser de Souza Kock, MSc, Department of Physiotherapy, University of South of Santa Catarina, José Acácio Moreira street, number 787, Tubarão, SC 88704-001, Brazil. kelserkock@yahoo.com.br
Telephone: +55-48-999969811
Received: August 28, 2017
Peer-review started: August 29, 2017
First decision: September 25, 2017
Revised: November 5, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: February 4, 2018
Processing time: 157 Days and 20.7 Hours
ARTICLE HIGHLIGHTS
Research background

The measurements of respiratory mechanics most frequently used are compliance and resistance of the respiratory system. Compliance is associated with distensibility of the respiratory system, which is resulting from the tidal volume variation divided by the peak inspiratory pressure. Resistance is related to the conduction of air, obtained mathematically from the variation between the peak and plateau pressures divided by the inspiratory airflow.

Research motivation

The aim is evaluate the predictive capability of respiratory mechanics for the development of VAP and mortality in the intensive care unit (ICU) of a hospital in southern Brazil.

Research objectives

Respiratory mechanics, ventilator-associated pneumonia.

Research methods

A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) modes in the 1st and 5th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients’ illness was quantified by the Acute Physiology and Chronic Health Evaluation II (APACHE II). The diagnosis of VAP was made based on clinical, radiological and laboratory parameters.

Research results

The significant associations found for the development of VAP were APACHE II scores above the average (P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average (P = 0.003), male gender (P = 0.004), and worsening of respiratory resistance in PCV mode (P = 0.010). Age above the average (P < 0.001), low level of oxygenation on day 1 (P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the outcome.

Research conclusions

The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.

Research perspectives

The results show that the respiratory function is a prognostic measure, and is strongly associated with mortality.