Clinical Application of P0.1

P0.1 trending to evaluate patient work of breathing while utilizing a low Vt strategy in a patient without ARDS (Grooms, D. 2006)

P0.1 may be used to evaluate ventilator settings, the above graph provides an example of how P0.1 trending was used to evaluate appropriate 'target' tidal volume settings in a patient without ARDS and a measured plateau pressure less than 25 cmH2O. 

• Click on the picture for a larger image. 

Notice in the above pictured graph the dramatic increase in both p0.1 (blue) and work of breathing (yellow) after switching the patient to a low tidal volume strategy.

Maintaining this strategy in this referenced patient would put them at risk for:

•  muscle fatigue
• ventilator asynchronies
•  higher sedation use
  
• prolonged mechanical ventilation. 

note-

"Forcing a tidal volume of 6 ml/kg on every patient can result in marked cardiovascular instability, as a result of the patient fighting the ventilator for a larger tidal volume. This increases the patients effort, discomfort, oxygen consumption, carbon dioxide production, and increases the complexity of managing the patient" (Kacmarek, R 2007). 

If the p0.1 is too high

• Decrease the trigger sensitivity.
• Shorten rise time (faster).
• Increase Flow rate.
• Change to a pressure mode.
• Increase the Driving pressure.
• Consider Proportional Assist Ventilation or Adaptive Support Ventilation. 

Reference

Grooms, D. (2006). P0.1 Trending to Evaluate Target Vt Settings. Excel Graph. Norfolk General Hospital. Norfolk, VA. 

Steinberg, K. & Kacmarek, R. (2007). Should Tidal Volume be 6 ml/kg Predicted Body Weight  in Virtually All Patients with Acute Respiratory Failure? Respiratory Care. 52 (5): 556