Abstract
We studied 20 unselected patients admitted to our Intensive Care Unit (ICU) suffering from acute respiratory failure (ARF), who needed mechanical ventilatory support. In all of them we followed a prospective protocol to investigate the value of mouth occlusion pressure (P0.1) as an indicator for weaning. Fifty-two tests were classified into three groups: a need to be reconnected to mechanical ventilation (MV), stable on intermittent mandatory ventilation (IMV), or spontaneous breathing on a T-tube (TT). The results showed that at increased values of P0.1 there were more difficulties in weaning patients from MV. Seventy-eight percent (78%) of the occasions where weaning was successful, values of P0.1 were ≤4.2 cm H2O, in chronic or non-chronic patients. Eighty-nine percent (89%) of the times when P0.1 values were higher than 4.2 cm H2O the same patients required ventilatory support, total (MV) or partial (IMV). These differences were statistically significant (p<0.01). We conclude that the P0.1 is an easily obtained non-invasive parameter, that can contribute along with other more conventional measurements to a superior indication for weaning.
Article PDF
Similar content being viewed by others
References
Whitelaw WA, Derenne JP, Milic-Emili J (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 23:181
Derenne JP (1977) Methodes d'investigation clinique des mecanismes regulateurs de la ventilation. Bull Eur Physiopathol Respir 13:681
Cherniac NS, Lederer DH, Altose MD (1976) Occlusion pressure as a technique in evaluating respiratory control Chest (Suppl) 70:137
Gelb AF, Klein E, Schiffman P (1977) Ventilatory response and drive in acute and COPD. Am Rev Respir Dis 116:9
Aubier M, Murciano D, Fournier M, Milic-Emili J (1980) Central respiratory drive in acute respiratory failure of patients with COPD. Am Rev Respir Dis 122:191
Gilbert R, Anchincloss JR, Peppi D, Ashutosh K (1974) The first few hours off a respirator. Chest 65:152
Cohen CA, Zagelbaum G, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Ann Intern Med 73:308
Downs JB, Perkins HM, Modell JH (1974) Intermittent mandatory ventilation. An evaluation. Arch Surg 109:159
Millbern SM, Downs JB, Jumper LC, Modell JH (1978) Evaluation of criteria of discontinuing mechanical ventilatory support. Arch Surg 113:1441
Manzano Alonso JL, Jato Velandie N, Leal Noval R (1984) Retirada de la ventilación mecanica. Weaning. Med Intens 8:1
Galen RS, Gambino SR (1975) Beyond normality: the predictive value and efficiency of medical diagnosis. John Wiley and Sons, New York
Griner PF, Mayewski RJ, Mushlin AS (1981) Selection and interpretation of diagnostic tests and procedures. Ann Intern Med 94 (Suppl): 553
Pardell Alenta H, Marcillas Vilaseca J, Fuentes Arderin J (1983) Criterios de selección de un procedimiento diagnostico. Med Clin (Barc) 80:37
Doménech i Massons JP (1980) Bioestadistica. Metodos estadisticos para investigadores. Herder, Barcelona
Derenne JP, Grassino A, Whitelaw WA, Milic-Emili J (1975) Occlusion pressure in normal, supine, man. Am Res Respir Dis 111:907
Palenciano L, de Vega A, Iisdro MI (1982) Presión de oclusión (P0.1) en sujetos normales y obstructivos con y sin retención de CO2. In: Mecanismos limitantes del flujo aereo. Neumosur, Sevilla, p 153
Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63:1002
Sahn SA, Lakshminarayan S, Petty T (1976) Weaning from mechanical ventilation. JAMA 203:2208
Feeby WT, Hedhlywhyte J (1975) Weaning from controlled ventilation and supplemented oxygen. N Engl J Med 292:903
Zagelbaum GL, Peter Paré JH (1982) Manual of acute respiratory care. Little Brown, Boston, p 226
Browne DRG (1984) Weaning patients from mechanical ventilation. Intensive Care Med 10:55
Millbern SM, Downs JB, Jumper LC (1978) Evaluation of criteria for discontinuing mechanical ventilatory support. Arch Surg 113:1441
Downs JB, Klein EF, Desantels D, Modell JH, Kirby RR (1973) Intermittent mandatory ventilation. A new approach to weaning patients from mechanical ventilators. Chest 64:331
Downs JB, Perkins HM, Modell JH (1974) Intermittent mandatory ventilation. Arch Surg 109:519
Chopin C, Fournier F, Chambrin MC (1983) Nouvelle technique du sevrage de l'assistance ventilatoire. Ventilation asservie à gaz carbonique. Presse Med 12:495
Benlloch Garcia E, Tagores Solidelles B, Marco Martinez V (1983) Metodos de estudio del control de la respiracion. Rev Clin Esp 5:165
Lopata ML, Evanich MJ, Onal E (1978) Airway occlusion pressures and respiratory nerve and muscle activity in studies of respiratory control Chest (Suppl) 73:252
Lopata ML, Evanich MJ, Lourenco RV (1976) The electromiogram of the diaphragm in the investigation of human regulation of respiration. Chest (Suppl) 70:162
Lopata ML, Lafata JL, Evanich MJ (1977) Effects of flow-resistive loading on mouth occlusion pressure during CO2 rebreathing Am Rev Respir Dis 115:73
Altose MD, Kelsen SG, Stanley NN (1976) Effects of hypercapnia in mouth occlusion pressure during airway occlusion in conscious man. J Clin Invest 40:388
Grassino A, Sorli J, Lorange G, Milic-Emili J (1978) Respiratory drive and timing in COPD. Chest (Suppl) 73:290
Sorli J, Grassino A, Lorange G, Milic-Emili J (1978) Control of breathing in patients with COPD. Clin Sci Mol Med 54:295
Alfageme Michavila I, Castillo Gomez J, Montemayor Rubio T (1982) Comportamientos de los flujos y la P0.1 en los EPOC con y sin retencion de CO2 ante el estimulo hiperoxico. In: Mecanismos limitantes del fljuo aereo. Neumosur, Sevilla, p 167
Macklem PT (1980) Respiratory muscles: the vital pump Chest 78:753
Roussos CH, Macklem PT (1982) The respiratory muscles. N Engl J Med 307:786
Milic-Emili J, Aubier M (1980) Some recent advances in study of the control of breathing in patients with COPD. Anesth Analg 59:865
Benlloch Garcia E, Tagores Solivellas B, Marco Martinez V (1983) Control de la ventilation en la obstrucion cronica al flujo aereo. Arch Bronconeumol 19:28
Milic-Emili J (1982) Recent advances in clinical assessment of control of breathing. Lung 160:1
Porter WT, Newburgh L (1971) Further evidence regarding the role of the vagus nerves in pneumonia. Am J Physiol 43:455
Trenchard D, Gardner D, Cruz A (1972) Role of pulmonary vagal afferent nerve fibers in the development of rapid, shallow breathing in lung inflamation. Clin Sci 42:163
Phillipson EN, Murphy E, Kozar LF, Schultze RK (1975) Role of the vagal stimuli in exercise ventilation in dogs with experimental pneumonitis. J Appl Physiol 39:76
Macklem PT, Roussos CH (1977) Respiratory muscle fatigue: a cause of respiratory failure. Clin Sci Mol Med 53:419
Holle RH, Montogomery RB, Schoene S(1983) High central respiratory drives in patients who fail ventilation weaning. Am Rev Respir Dis 127 (part 2):88
Woodrow WJ, Rossing TH, Ingram RH (1983) Effect of IMV on respiratory drive and timing. Am Rev Respir Dis 127:705
Menn SJ, Stool EW (1980) Mechanical ventilation. Weaning and complications. In: Manual of clinical problems in pulmonary medicine. Little Brown, Boston, p 264
Petty TL (1984) Acute respiratory failure in chronic obstructive pulmonary disease. In: Shoemaker, Thompson, Holbrook (eds) Textbook of critical care. Saunders, Philadelphia, p 264
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Herrera, M., Blasco, J., Venegas, J. et al. Mouth occlusion pressure (P0.1) in acute respiratory failure. Intensive Care Med 11, 134–139 (1985). https://doi.org/10.1007/BF00258538
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00258538