Document Detail


Respiratory load compensation during mechanical ventilation--proportional assist ventilation with load-adjustable gain factors versus pressure support.
MedLine Citation:
PMID:  16523329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: In mechanically ventilated patients respiratory system impedance may vary from time to time, resulting, with pressure modalities of ventilator support, in changes in the level of assistance. Recently, implementation of a closed-loop adjustment to continuously adapt the level of assistance to changes in respiratory mechanics has been designed to operate with proportional assist ventilation (PAV+). OBJECTIVES: The aim of this study was to assess, in critically ill patients, the short-term steady-state response of respiratory motor output to added mechanical respiratory load during PAV+ and during pressure support (PS). PATIENTS AND INTERVENTIONS: In 10 patients respiratory workload was increased and the pattern of respiratory load compensation was examined during both modes of support. MEASUREMENTS AND RESULTS: Airway and transdiaphragmatic pressures, volume and flow were measured breath by breath. Without load, both modes provided an equal support as indicated by a similar pressure-time product of the diaphragm per breath, per minute and per litre of ventilation. With load, these values were significantly lower (p<0.05) with PAV+ than those with PS (5.1+/-3.7 vs 6.1+/-3.4 cmH2O.s, 120.9+/-77.6 vs 165.6+/-77.5 cmH2O.s/min, and 18.7+/-15.1 vs 24.4+/-16.4 cmH2O.s/l, respectively). Contrary to PS, with PAV+ the ratio of tidal volume (VT) to pressure-time product of the diaphragm per breath (an index of neuroventilatory coupling) remained relatively independent of load. With PAV+ the magnitude of load-induced VT reduction and breathing frequency increase was significantly smaller than that during PS. CONCLUSION: In critically ill patients the short-term respiratory load compensation is more efficient during proportional assist ventilation with adjustable gain factors than during pressure support.
Authors:
Eumorfia Kondili; George Prinianakis; Christina Alexopoulou; Eleftheria Vakouti; Maria Klimathianaki; Dimitris Georgopoulos
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Publication Detail:
Type:  Journal Article     Date:  2006-03-08
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-25     Completed Date:  2007-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  692-9     Citation Subset:  IM    
Affiliation:
Intensive Care Medicine Department, University Hospital of Heraklion, Heraklion, 711 10, Crete, Greece.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Female
Greece
Humans
Intensive Care Units
Male
Middle Aged
Respiration, Artificial / methods*
Work of Breathing / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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