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Effects of chest wall loading in supine position on respiratory mechanics in low-compliance ARDS patients
Wenwen Yan1, Li Peng2, Jian Zhang3
1Department of Critical Care Medicine, Hebei Medical University Shijiazhuang 050000, Hebei, China; Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang 050000, Hebei, China; Department of Intensive Care Unit, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China.
Background:
Acute respiratory distress syndrome (ARDS) remains a life-threatening condition in critically ill patients. Chest wall loading has been proposed as a potential intervention to improve respiratory mechanics in specific ARDS phenotypes, but evidence from large cohorts is lacking.
Objectives:
This study aimed to investigate the effects of acute chest wall loading on respiratory mechanics in patients with low-compliance ARDS.
Methods:
A prospective study included 76 patients with severe pneumonia-induced ARDS (PaO2/FiO2 ≤150, Crs ≤35 mL/cmH2O). A 5 kg sandbag was applied to the anterior chest wall in the supine position. Respiratory mechanics (respiratory system compliance-Crs, plateau pressure-Pplat, driving pressure-DP, intrinsic and total PEEP), hemodynamic parameters (heart rate-HR, mean arterial pressure-MAP), and oxygenation index (PaO2/FiO2) were measured before and 30 min after loading. Ventilator settings remained unchanged.
Results:
Chest wall loading significantly improved respiratory system compliance (median increase 4.8 mL/cmH2O, P < 0.001) and reduced both plateau pressure (median decrease 2.1 cmH2O, P < 0.001) and driving pressure (median decrease 2.3 cmH2O, P < 0.001). No significant changes occurred in HR, MAP, or PaO2/FiO2. Improvements were more pronounced in patients with lower baseline compliance (Spearman's ρ = -0.420, P < 0.001).
Conclusion:
Acute chest wall loading with a 5 kg sandbag significantly improves respiratory mechanics in low-compliance ARDS patients by enhancing compliance and reducing plateau and driving pressures, without compromising hemodynamics or oxygenation. This simple intervention may serve as a useful adjunct to lung-protective ventilation in this subset of patients.
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