Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
Por:
Rittayamai, N, Beloncle, F, Goligher, EC, Chen, L, Mancebo, J, Richard, JCM, Brochard, L
Publicada:
6 oct 2017
Resumen:
Background: In pressure-controlled (PC) ventilation, tidal volume (V-T) and transpulmonary pressure (P-L) result from the addition of ventilator pressure and the patient's inspiratory effort. PC modes can be classified into fully, partially, and non-synchronized modes, and the degree of synchronization may result in different V-T and P-L despite identical ventilator settings. This study assessed the effects of three PC modes on V-T, P-L, inspiratory effort (esophageal pressure-time product, PTPes), and airway occlusion pressure, P-0.1. We also assessed whether P-0.1 can be used for evaluating patient effort.
Methods: Prospective, randomized, crossover physiologic study performed in 14 spontaneously breathing mechanically ventilated patients recovering from acute respiratory failure (1 subsequently withdrew). PC modes were fully (PC-CMV), partially (PC-SIMV), and non-synchronized (PC-IMV using airway pressure release ventilation) and were applied randomly; driving pressure, inspiratory time, and set respiratory rate being similar for all modes. Airway, esophageal pressure, P-0.1, airflow, gas exchange, and hemodynamics were recorded.
Results: V-T was significantly lower during PC-IMV as compared with PC-SIMV and PC-CMV (387 +/- 105 vs 458 +/- 134 vs 482 +/- 108 mL, respectively; p < 0.05). Maximal P-L was also significantly lower (13.3 +/- 4.9 vs 15.3 +/- 5.7 vs 15.5 +/- 5.2 cmH(2)O, respectively; p < 0.05), but PTPes was significantly higher in PC-IMV (215.6 +/- 154.3 vs 150.0 +/- 102.4 vs 130.9 +/- 101.8 cmH(2)O x s x min(-1), respectively; p < 0.05), with no differences in gas exchange and hemodynamic variables. PTPes increased by more than 15% in 10 patients and by more than 50% in 5 patients. An increased P-0.1 could identify high levels of PTPes.
Conclusions: Non-synchronized PC mode lowers V-T and P-L in comparison with more synchronized modes in spontaneously breathing patients but can increase patient effort and may need specific adjustments.
Filiaciones:
Rittayamai, N:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Li Ka Shing Knowledge Inst, 30 Bond St, Toronto, ON M5B 1W8, Canada
Siriraj Hosp, Div Resp Dis & TB, Dept Med, Fac Med, Bangkok, Thailand
Beloncle, F:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Li Ka Shing Knowledge Inst, 30 Bond St, Toronto, ON M5B 1W8, Canada
Univ Angers, Med Intens Care Unit, Hosp Angers, Angers, France
Goligher, EC:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Toronto, Dept Med, Toronto, ON, Canada
Univ Toronto, Dept Physiol, Toronto, ON, Canada
Univ Hlth Network, Div Respirol, Dept Med, Toronto, ON, Canada
Mt Sinai Hosp, Toronto, ON, Canada
Chen, L:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Li Ka Shing Knowledge Inst, 30 Bond St, Toronto, ON M5B 1W8, Canada
Mancebo, J:
Univ Montreal, CRCHUM, Montreal, PQ, Canada
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Richard, JCM:
Gen Hosp Annecy, Emergency Dept, Annecy, France
INSERM, UMR Eq 13 955, Creteil, France
Brochard, L:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Li Ka Shing Knowledge Inst, 30 Bond St, Toronto, ON M5B 1W8, Canada
Gold, Green Published
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