Mean airway pressure has the potential to become the core pressure indicator of mechanical ventilation: Raising to the front from behind the clinical scenes

Longxiang Su, Pan Pan, Dawei Liu, Yun Long, Longxiang Su, Pan Pan, Dawei Liu, Yun Long

Abstract

Mean airway pressure (Pmean) is a common pressure monitoring parameter of mechanical ventilators that is closely correlated with mean alveolar pressure and represents stresses applied to the lung parenchyma during ventilation. Pmean is determined by the peak inspiratory pressure, positive end-expiratory pressure (PEEP), and inspiratory-to-expiratory time ratio with dynamic and real-time characteristics, which represents mechanical power affected by the ventilator mode. Additionally, Pmean is an important parameter that affects hemodynamics. Tidal forces and PEEP increase pulmonary vascular resistance (PVR) in direct proportion to their effects on Pmean. Therefore, Pmean is increasingly considered to be related to the prognosis of patients on mechanical ventilation. We propose a 3P strategy (Pmean, central venous pressure [CVP], and perfusion index [PI]) which is indicated to achieve circulation protection mechanical ventilation with flow priority. Titrating the appropriate CVP and meeting PI to ensure tissue perfusion with a lower Pmean are the core purposes. Pmean links the circulatory and respiratory systems and is expected to become a potential parameter for intelligent ventilation.

Keywords: Central venous pressure; Circulation protection; Mean airway pressure; Mechanical ventilation; Perfusion index.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2021 Chinese Medical Association. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Flow prioritized 3P (Pmean, CVP, and PI)  Circulation Protective Ventilation Strategy. Gas accompanied by blood flow. If the Pmean increases >10 cmH2O, the CVP may increase to >10 mmHg based on the cardiopulmonary interaction. Then, the blood flow will be disrupted, leading to perfusion injury based on PI < 1.4. ARDS: Acute respiratory distress syndrome; CVP: Central venous pressure; ICU: Intensive care unit; PI: Perfusion index.

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Source: PubMed

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