Asynchronous Breathing Movements in Patients with Chronic Obstructive Pulmonary Disease

Kumar, Ashutosh; Gilbert, Robert; Auchincloss, J. Howland; Peppi, David

doi:10.1378/chest.67.5.553

Cited by 101 publications

(41 citation statements)

References 9 publications

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“…16 It should be noted that this breathing pattern was described prior to the discovery of intrinsic PEEP, with its associated threshold loading, uncaptured inspiratory efforts, and recruitment of abdominal expiratory muscles that also might contribute to the clinical impression of discoordinated breathing. 17,18 Yet proponents of IMV emphasized discoordinated breathing and prolonged weaning following passive mechanical ventilation as a justification for promoting spontaneous breathing throughout the course of mechanical ventilation.…”

Section: Discoordinated Breathingmentioning

confidence: 89%

Patient-Ventilator Interaction During Acute Lung Injury, and the Role of Spontaneous Breathing: Part 1: Respiratory Muscle Function During Critical Illness

Kallet

2011

Respir Care

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SummarySince the early 1970s there has been an ongoing debate regarding the wisdom of promoting unassisted spontaneous breathing throughout the course of critical illness in patients with severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. Historically, the term "disuse atrophy" has described a situation wherein sustained inactivity of the respiratory muscles (ie, passive ventilation) results in deconditioning and weakness. More recently it has been referred to as "ventilator-induced diaphragmatic dysfunction." In contrast, "use atrophy" describes a situation where chronic high-tension inspiratory work causes structural damage to the diaphragm and weakness. Both laboratory and clinical studies demonstrated that relatively brief periods of complete respiratory muscle inactivity, as well as intense muscle loading, result in acute inflammation, loss of muscle mass, and weakness. Yet in critical illness other factors also affect respiratory muscle function, including prolonged use of neuromuscular blocking agents, administration of corticosteroids, and sepsis. This makes the attribution of acquired respiratory muscle weakness and ventilator-dependence to either ventilator-induced diaphragmatic dysfunction or loaded breathing extremely difficult. Regardless, the clinical implications of this research strongly suggest that passive mechanical ventilation should be avoided whenever possible. However, promotion of unassisted spontaneous breathing in the acute phase of critical illness also may carry a substantial risk of respiratory muscle injury and weakness. Use of mechanical ventilation modes in a manner that induces spontaneous breathing effort, while simultaneously reducing the work load on the respiratory muscles, is probably sufficient to minimize both problems. Key words: acute lung injury; acute respiratory distress syndrome; discoordinated breathing; disuse atrophy; respiratory muscle fatigue; ventilator-induced diaphragmatic dysfunction; use atrophy. [Respir Care 2011;56(2):181-189.

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Section: Discoordinated Breathingmentioning

confidence: 89%

Patient-Ventilator Interaction During Acute Lung Injury, and the Role of Spontaneous Breathing: Part 1: Respiratory Muscle Function During Critical Illness

Kallet

2011

Respir Care

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“…17,18 Missed triggers can be the result of inappropriate trigger sensitivity setting, respiratory muscle weakness, diminished respiratory drive, dynamic hyperinflation, or a combination of these factors. Dynamic hyperinflation associated with large V T during pressure support ventilation (PSV) in patients with elevated airways resistance and normal pulmonary compliance (eg, COPD) are the most often described reason for missed triggers.…”

Section: Missed Triggersmentioning

confidence: 99%

“…Dynamic hyperinflation associated with large V T during pressure support ventilation (PSV) in patients with elevated airways resistance and normal pulmonary compliance (eg, COPD) are the most often described reason for missed triggers. [17][18][19][20][21][22][23] Missed triggers can also occur during volume control ventilation.…”

Section: Missed Triggersmentioning

confidence: 99%

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Asynchrony and DyspneaDiscussion

2013

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SummaryPatient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.

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“…Breathing is often the first vital sign to alter in an acutely deteriorating patient, because changes in breathing pattern accompany many respiratory [1][2][3] and non-respiratory disorders [4]. Abnormal breathing patterns have also been observed in patients with chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) [5], bronchiectasis [6] and asthma [7].…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of Recording Speech Breathing Patterns before and after Pulmonary Rehabilitation in an Out-Patient Environment

Tehrany

Bruton²,

Barney³

2016

J Pulm Respir Med

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Asynchronous Breathing Movements in Patients with Chronic Obstructive Pulmonary Disease

Cited by 101 publications

References 9 publications

Patient-Ventilator Interaction During Acute Lung Injury, and the Role of Spontaneous Breathing: Part 1: Respiratory Muscle Function During Critical Illness

Patient-Ventilator Interaction During Acute Lung Injury, and the Role of Spontaneous Breathing: Part 1: Respiratory Muscle Function During Critical Illness

Asynchrony and DyspneaDiscussion

The Feasibility of Recording Speech Breathing Patterns before and after Pulmonary Rehabilitation in an Out-Patient Environment

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