Clinical value of setting ventilator parameters according to respiratory mechanics for the patients without ARDS undergoing mechanical ventilation

Li Zhiang; Jiang Yiling; Li Peifang; Liu Yichang; Zhu Jianliang; Zhu Jianjun; Liu Lijun

doi:10.3969/j.issn.1002-1949.2025.04.012

Abstract：Objective To investigate the clinical value of setting ventilator parameters by measuring plateau pressure(Pplat)and driving pressure(ΔP)in mechanically ventilated patients without acute respiratory distress syndrome(ARDS).Methods This study was a before-after comparison study.The 31 patients with endotracheal intubation and invasive mechanical ventilation for more than 24 h in intensive care unit(ICU)of the Second Affiliated Hospital of Soochow university from February 2022 to December 2022 were enrolled.The patients with respiratory parameters set according to clinical experience were designed as the pre-intervention group,the patients with ventilator parameters set according to respiratory mechanics were designed as the intervention group,and the results of respiratory mechanics and arterial blood gas before and after the intervention were compared.The difference between the two groups was in accordance with normal distribution,and paired t test was performed.If the difference did not conform to the normal distribution,the non-parametric Wilcoxon test was used.Results Analysis of respiratory mechanics indicators showed the mean airway pressure(Pmean)[cmH2O:9(9,10)vs.11(10,3),P＜0.01]and plateau pressure(cmH2O:17±2 vs.21±3,P＜0.01)were significantly decreased in the intervention group compared with the pre-intervention group.The tidal volume(VT)was also significantly reduced(mL:459±81 vs.549±112,P＜0.01).Arterial blood gas analysis showed that PaO2/FiO2 was significantly improved after intervention(mmHg:257±95 vs.241±87,P＜0.01),and arterial partial pressure of carbon dioxide(PaCO2)was slightly increased(mmHg:40±7 vs.39±7,P＜0.05).There were no significant differences in other metabolic indexes such as arterial blood lactic acid(Lac).Conclusions Compared with the empirical ventilation parameter setting,the ventilation setting guided by respiratory mechanics parameters can improve oxygenation and reduce the ventilation pressure of lung tissue in the patients without ARDS,and may have a protective effect on lung tissue.