Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.

Détails

ID Serval
serval:BIB_81FEF795A63D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.
Périodique
American Journal of Respiratory and Critical Care Medicine
Auteur(s)
Tassaux D., Gainnier M., Battisti A., Jolliet P.
ISSN
1073-449X (Print)
ISSN-L
1073-449X
Statut éditorial
Publié
Date de publication
2005
Peer-reviewed
Oui
Volume
172
Numéro
10
Pages
1283-1289
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
RATIONALE: During pressure-support ventilation, the ventilator cycles into expiration when inspiratory flow decreases to a given percentage of peak inspiratory flow ("expiratory trigger"). In obstructive disease, the slower rise and decrease of inspiratory flow entails delayed cycling, an increase in intrinsic positive end-expiratory pressure, and nontriggering breaths.
OBJECTIVES: We hypothesized that setting expiratory trigger at a higher than usual percentage of peak inspiratory flow would attenuate the adverse effects of delayed cycling.
METHODS: Ten intubated patients with obstructive disease undergoing pressure support were studied at expiratory trigger settings of 10, 25, 50, and 70% of peak inspiratory flow.
MEASUREMENTS: Continuous recording of diaphragmatic EMG activity with surface electrodes, and esophageal and gastric pressures with a dual-balloon nasogastric tube.
MAIN RESULTS: Compared with expiratory trigger 10, expiratory trigger 70 reduced the magnitude of delayed cycling (0.25 +/- 0.18 vs. 1.26 +/- 0.72 s, p < 0.05), intrinsic positive end-expiratory pressure (4.8 +/- 1.9 vs. 6.5 +/- 2.2 cm H(2)O, p < 0.05), nontriggering breaths (2 +/- 3 vs. 9 +/- 5 breaths/min, p < 0.05), and triggering pressure-time product (0.9 +/- 0.8 vs. 2.1 +/- 0.7 cm H2O . s, p < 0.05).
CONCLUSIONS: Setting expiratory trigger at a higher percentage of peak inspiratory flow in patients with obstructive disease during pressure support improves patient-ventilator synchrony and reduces inspiratory muscle effort. Further studies should explore whether these effects can influence patient outcome.
Mots-clé
Aged, Female, Humans, Male, Positive-Pressure Respiration/methods, Pulmonary Disease, Chronic Obstructive/therapy, Respiratory Muscles/physiology, Ventilator Weaning, Work of Breathing/physiology
Pubmed
Web of science
Création de la notice
27/06/2013 15:32
Dernière modification de la notice
03/03/2018 18:49
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