Prevalence and prognosis of respiratory pendelluft phenomenon in mechanically ventilated ICU patients with acute respiratory failure: a retrospective cohort study

Yi Chi, Zhanqi Zhao, Inéz Frerichs, Yun Long, Huaiwu He, Yi Chi, Zhanqi Zhao, Inéz Frerichs, Yun Long, Huaiwu He

Abstract

Background: Respiratory pendelluft phenomenon, defined as intrapulmonary gas redistribution caused by asynchronous alveolar ventilation, could be potentially harmful by inducing lung injury. The aim of the present study was to investigate its prevalence and prognosis in intensive care unit (ICU) patients with acute respiratory failure (ARF).

Methods: This was a retrospective observational study on 200 mechanically ventilated ARF patients treated in a tertiary ICU. The presence of pendelluft was determined using electrical impedance tomography (EIT) within 48 h after admission. Its amplitude was defined as the impedance difference between the sum of all regional tidal impedance variation and the global tidal impedance variation. A value above 2.5% (the 95th percentile from 30 healthy volunteers) was considered confirmative for its occurrence.

Results: Pendelluft was found in 61 patients (39 in 94 patients with spontaneous breathing, 22 in 106 receiving controlled ventilation), with an overall prevalence of 31%. Existence of spontaneous breathing and higher global inhomogeneity index were associated with pendelluft. Patients with pendelluft had a longer ICU length of stay [10 (6, 14) vs. 7 (4, 11) days; median (lower, upper quartile); p = 0.022] and shorter 14-day ventilator-free days [8 (1, 10) vs. 10 (6, 12) days; p = 0.015]. Subgroup survival analysis suggested the association between pendelluft and longer ventilation duration, which was significant only in patients with PaO2/FiO2 ratio below 200 mmHg (log-rank p = 0.042). ICU mortality did not differ between the patients with and without pendelluft.

Conclusions: Respiratory pendelluft occurred often in our study group and it was associated with longer ventilation duration. Early recognition of this phenomenon should trigger interventions aimed at alleviating pendelluft.

Keywords: Acute respiratory failure; Intensive care unit; Mechanical ventilation; Pendelluft.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Exploration of correlation between PEEP and pendelluft amplitude in A P/F ratio below 150 mmHg and B presence of spontaneous breathing, respectively
Fig. 2
Fig. 2
Kaplan–Meier 14-day probability of discontinuation from ventilation curve for patients with (blue) or without pendelluft (red) in A the overall study population, B in patients with PaO2/FiO2 ratio below 200 mmHg and C between 200 and 300 mmHg
Fig. 3
Fig. 3
Relationship between pendelluft amplitude and risk ratio for ventilation discontinuation in the study population. 2.5% amplitude of pendelluft was set as the reference

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