• Anne-Fleur Haudebourg, Elsa Moncomble, Arnaud Lesimple, Flora Delamaire, Bruno Louis, Armand Mekontso Dessap, Alain Mercat, Jean-Christophe Richard, François Beloncle, and Guillaume Carteaux.
• Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.
• Crit Care. 2023 Jul 7; 27 (1): 273273.

BackgroundAirway opening pressure (AOP) detection and measurement are essential for assessing respiratory mechanics and adapting ventilation. We propose a novel approach for AOP assessment during volume assist control ventilation at a usual constant-flow rate of 60 L/min.ObjectivesTo validate the conductive pressure (Pcond) method, which compare the Pcond-defined on the airway pressure waveform as the difference between the airway pressure level at which an abrupt change in slope occurs at the beginning of insufflation and PEEP-to resistive pressure for AOP detection and measurement, and to compare its respiratory and hemodynamic tolerance to the standard low-flow insufflation method.MethodsThe proof-of-concept of the Pcond method was assessed on mechanical (lung simulator) and physiological (cadavers) bench models. Its diagnostic performance was evaluated in 213 patients, using the standard low-flow insufflation method as a reference. In 45 patients, the respiratory and hemodynamic tolerance of the Pcond method was compared with the standard low-flow method.Measurements And Main ResultsBench assessments validated the Pcond method proof-of-concept. Sensitivity and specificity of the Pcond method for AOP detection were 93% and 91%, respectively. AOP obtained by Pcond and standard low-flow methods strongly correlated (r = 0.84, p < 0.001). Changes in SpO2 were significantly lower during Pcond than during standard method (p < 0.001).ConclusionDetermination of Pcond during constant-flow assist control ventilation may permit to easily and safely detect and measure AOP.© 2023. The Author(s).

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