Potentially harmful effects of inspiratory synchronization during pressure preset ventilation.

Details

Serval ID
serval:BIB_901887FDDF2B
Type
Article: article from journal or magazin.
Collection
Publications
Title
Potentially harmful effects of inspiratory synchronization during pressure preset ventilation.
Journal
Intensive Care Medicine
Author(s)
Richard J.C., Lyazidi A., Akoumianaki E., Mortaza S., Cordioli R.L., Lefebvre J.C., Rey N., Piquilloud L., Sferrazza Papa G.F., Sferrazza-Papa G.F., Mercat A., Brochard L.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
39
Number
11
Pages
2003-2010
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
PURPOSE: Pressure preset ventilation (PPV) modes with set inspiratory time can be classified according to their ability to synchronize pressure delivery with patient's inspiratory efforts (i-synchronization). Non-i-synchronized (like airway pressure release ventilation, APRV), partially i-synchronized (like biphasic airway pressure), and fully i-synchronized modes (like assist-pressure control) can be distinguished. Under identical ventilatory settings across PPV modes, the degree of i-synchronization may affect tidal volume (VT), transpulmonary pressure (PTP), and their variability. We performed bench and clinical studies.
METHODS: In the bench study, all the PPV modes of five ventilators were tested with an active lung simulator. Spontaneous efforts of -10 cmH2O at rates of 20 and 30 breaths/min were simulated. Ventilator settings were high pressure 30 cmH2O, positive end-expiratory pressure (PEEP) 15 cmH2O, frequency 15 breaths/min, and inspiratory to expiratory ratios (I:E) 1:3 and 3:1. In the clinical studies, data from eight intubated patients suffering from acute respiratory distress syndrome (ARDS) and ventilated with APRV were compared to the bench tests. In four additional ARDS patients, each of the PPV modes was compared.
RESULTS: As the degree of i-synchronization among the different PPV modes increased, mean VT and PTP swings markedly increased while breathing variability decreased. This was consistent with clinical comparison in four ARDS patients. Observational results in eight ARDS patients show low VT and a high variability with APRV.
CONCLUSION: Despite identical ventilator settings, the different PPV modes lead to substantial differences in VT, PTP, and breathing variability in the presence spontaneous efforts. Clinicians should be aware of the possible harmful effects of i-synchronization especially when high VT is undesirable.
Pubmed
Web of science
Create date
17/01/2014 12:21
Last modification date
03/03/2018 19:24
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