Detection of unsuspected imposed work of breathing

Kirton, Orlando C.; Banner, Michael J.; Axelrad, Alexander; Drugas, George T.

doi:10.1097/00003246-199305000-00025

Cited by 32 publications

(19 citation statements)

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“…This may be due to an initial mismatch between the gas flow rate delivered by the ventilator and the patient9s spontaneous demand for airflow. Similar results were found by others both during assistcontrol ventilation [2] and pressure-support ventilation [8][9][10] or continuous positive airway pressure [23].…”

Section: Discussionsupporting

confidence: 91%

The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation

et al. 2001

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The aim of this study was to investigate the effects of different pressurization rates during pressure support ventilation on breathing pattern, work of breathing, gas exchange and patient comfort in patients with acute lung injury. The pressurization rate modifies the initial pressure ramp by changing the initial peak flow rate: the increase in pressurization rate is associated with a decrease in the time to reach the level of pressure support ventilation by increasing the peak flow rate.Ten intubated patients (age 64¡17 yrs, body mass index 24¡17 Kg?m -2 , arterial oxygen tension/inspired oxygen fraction 214¡59) were studied in random order varying the pressurization rate at 5 and 15 cmH 2 O of pressure support ventilation. Breathing comfort was evaluated by a visual analogue scale.Increasing the pressurization rate caused an increase of peak flow rate from 473¡141 mL?s -1 to 758¡302 mL?s -1 at pressure support ventilation 5 (pv0.05) and from 481¡126 mL?s -1 to 1,121¡175 mL?s -1 at pressure support ventilation 15 (pv0.05). At the lowest pressurization rate the tidal volume was the lowest, the respiratory rate and the work of breathing were the highest (pv0.05) compared with other pressurization rates. Excluding the lowest pressurization rate, in all the other pressurization rates tested the breathing pattern and the work of breathing did not change. The lowest and the highest pressurization rates caused the worst patient comfort (pv0.05). The gas exchange was stable throughout the study.The presented results suggest: 1) the lowest pressurization rate caused the lowest tidal volume, highest respiratory rate and highest work of breathing; 2) at the other pressurization rates no differences in breathing pattern and work of breathing were observed; and 3) the patient9s comfort was worse at the lowest and highest pressurization rates.

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Section: Discussionsupporting

confidence: 91%

The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation

et al. 2001

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“…Imposed resistance through any or all of the airways during exhalation can produce alveolar hyperinflation, uneven regional ventilation, and excessive respiratory muscle loading, leading to increased work of breathing, impaired gas exchange, 16 and failure to wean. [17][18][19][20][21][22] As expected, the pressure-relief valve had an appreciable effect on the magnitude and frequency of the ⌬P tracheal (see Figs. 6 and 7) but did little to decrease mean P tracheal (see Fig.…”

Section: Discussionmentioning

confidence: 74%

Effects of Condensate in the Exhalation Limb of Neonatal Circuits on Airway Pressure During Bubble CPAP

2013

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“…The system has been already described and validated. [9][10][11] Ten consecutive respiratory cycles were averaged to determine respiratory rate (RR), tidal volume (TV), inspiratory time (Ti), inspiratory duty cycle, i.e., the duration of a whole breathing cycle (Ttot), and mean inspiratory flow (TV/Ti). Airway occlusion pressure after 100 msec (P 01 ) was obtained by activating the expiratory pause knob of the ventilator.…”

Section: Methodsmentioning

confidence: 99%

A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients

Cavaliere

Antonelli

Arcangeli

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To study the analgesic and sedative effects of remifentanil in critically-ill patients.M Me et th ho od ds s: : Remifentanil infusion was started at 0.02 µg·kg -1 ·min -1 in ten mechanically ventilated critically-ill patients, and the infusion rate was increased to 0.05, 0.10, 0.15, 0.20, and 0.25 µg·kg -1 ·min -1 every 30 min. Basally and 25 min after each increase we measured: the Ramsey sedation score (RSS) and the respiratory response subscore of comfort scale (CSRR); the bispectral index (BIS) before and after lightly touching tracheal mucosa; heart rate and systemic arterial pressure; respiratory variables; plasma epinephrine and norepinephrine levels.R Re es su ul lt ts s: : Infusion rates up to 0.05 µg·kg -1 ·min -1 were effective against agitation and achieved a good degree of adaption to the respirator in all patients (RSS 2 or more and CSRR 3 or less); BIS decreased significantly; respiratory and circulatory variables were unaffected; mean plasma epinephrine levels decreased. At infusion rates higher than 0.05 µg·kg -1 ·min -1 RSS but not BIS decreased further and patient arousability caused by noxious stimuli was not prevented; respiratory drive suppression occurred at the infusion rates higher than 0.05 µg·kg -1 ·min -1 in four patients; bradycardia and arterial hypotension was observed in three patients; plasma epinephrine levels decreased significantly, while norepinephrine was unaffected; severe itching was experienced by one patient.C Co on nc cl lu us si io on ns s: : Low doses of remifentanil (up to 0.05 µg·kg -1 ·min -1 ) can be useful in critically-ill patients in order to achieve calm and sedation. Higher doses can inhibit respiratory drive and require controlled mechanical ventilation. Objectif

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Detection of unsuspected imposed work of breathing

Cited by 32 publications

References 0 publications

The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation

The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation

Effects of Condensate in the Exhalation Limb of Neonatal Circuits on Airway Pressure During Bubble CPAP

A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients

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