Patient–Ventilator Interaction

Tobin, Martin J.; Jubran, Amal; Laghi, Franco

doi:10.1164/ajrccm.163.5.2005125

Cited by 215 publications

(140 citation statements)

References 78 publications

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“…Thus, PSV may adapt to breath-to-breath variability [27] more precisely than APCV, where the mechanical inflation stops after a preset time. However, the present authors found no differences in the patient/ ventilator interaction [28] (e.g. breathing pattern, WOB, gas exchange) with PSV and APCV.…”

Section: Pressure Support Ventilation and Assist Pressure Control Vencontrasting

confidence: 88%

Different modes of assisted ventilation in patients with acute respiratory failure

Chiumello¹,

Pelosi²,

Calvi³

et al. 2002

Eur Respir J

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The aim of the present study was to verify that the patient/ventilator interaction is similar, regardless of the mode of assisted mechanical ventilation (i.e. pressure-or volume-limited) used, if tidal volume (VT) and peak inspiratory flow (PIF) are matched. Therefore, the authors compared the effects of three different modes of assisted ventilation on the work of breathing (WOB) and gas exchange in patients with acute respiratory failure.For Protocol 1, in seven patients, the authors compared pressure support, assist pressure control and assist control (with square and decelerating wave inspiratory flow pattern) set to deliver the same VT and PIF. For Protocol 2, in another 10 patients, the authors compared pressure support and assist control with high (0.8 L?s -1 ) and low (0.6 L?s -1 ) PIFs set to deliver the same VT.In Protocol 1, there was no difference in WOB and gas exchange between the three modes of assisted ventilation tested. In Protocol 2, the decrease of PIFs during assist control significantly increased WOB.In conclusion, different modes of assisted ventilation similarly reduce work of breathing and provide adequate gas exchange at fixed tidal volume and peak inspiratory flow only. During assist control, tidal volume and peak inspiratory flow (set by the physician) are the main determinants of the patient/ventilator interaction. A primary goal of mechanical ventilation is to improve gas exchange and reduce the work of breathing (WOB) of patients with acute respiratory failure, without causing iatrogenic lung injury [1]. Assisted ventilation allows the patient to contribute to minute ventilation (V9E) and offers several advantages over controlled ventilation. It can reduce the need for sedation and paralysis, decrease the risk of barotrauma [2], improve intrapulmonary gas distribution [3], and prevent muscle atrophy [4,5]. During assisted ventilation, the WOB is dependent on both the ventilator settings and the patient9s ventilatory demand and mechanics.Pressure support ventilation (PSV) is a pressurelimited, flow-cycled mode of assisted ventilation, in which each breath is supported by a constant level of pressure at the airway (Paw), so that the tidal volume (VT) and inspiratory flow are more adaptable to the patient9s own ventilatory demand [6]. This manner of supporting the patient9s own ventilatory effort may be responsible for an improved comfort and synchrony with the ventilator, and has been shown to reduce the WOB and prevent diaphragmatic fatigue in patients with respiratory failure [7]. The main disadvantage of PSV is that it only works best in patients with stable respiratory conditions (i.e. an adequate sufficient ventilatory drive and somewhat preserved respiratory mechanics [8,9]).Assist control ventilation (ACV) is a volume-limited mode of assisted ventilation, in which the VT and the peak inspiratory flow (PIF) are set by the clinician and are not altered by the patient9s ventilatory demand. If the required VT and inspiratory flow are higher than what the ventilator suppli...

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Section: Pressure Support Ventilation and Assist Pressure Control Vencontrasting

confidence: 88%

Different modes of assisted ventilation in patients with acute respiratory failure

Chiumello¹,

Pelosi²,

Calvi³

et al. 2002

Eur Respir J

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“…21 For example, if mechanical T I lasts longer than neural T I , the patient initiates expiration while the ventilator continues to deliver gas. Conversely, when neural T I exceeds mechanical T I , the patient continues in an inspiratory effort but the ventilator has cycled to expiration.…”

Section: Factors To Consider In Analyzing the Prevalence Of Patient-vmentioning

confidence: 99%

How Often Does Patient-Ventilator Asynchrony Occur and What Are the Consequences?

Epstein

2011

Respir Care

118

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Mechanical ventilation can be life-saving for patients with acute respiratory failure. In between the 2 extremes of complete and no ventilatory support, both patient and machine contribute to ventilatory work. Ideally, ventilator gas delivery would perfectly match patient demand. This patientventilator interaction depends on how the ventilator responds to patient respiratory effort and, in turn, how the patient responds to the breath delivered by the ventilator. It is now evident that the interaction between patient and ventilator is frequently suboptimal and that patient-ventilator asynchrony is common. Its prevalence depends on numerous factors, including timing and duration of observation, technique used for detection, patient population, type of asynchrony, ventilation mode and settings (eg, trigger, flow, and cycle criteria), and confounding factors (eg, state of wakefulness, sedation). Patient-ventilator asynchrony is associated with adverse effects, including higher/wasted work of breathing, patient discomfort, increased need for sedation, confusion during the weaning process, prolonged mechanical ventilation, longer stay, and possibly higher mortality. Whether asynchrony is a marker of poor prognosis or causes these adverse outcomes remains to be determined.

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“…Maskeden kaçaklar, ventilatör ayarlarının uygun yapılması da toleransı etkiler. 17,21,22 AVAPS ile inspiratuar basıncın erken ve uygun titrasyonunun sağlanabile-ceği öngörülmektedir. Çalışmamızda AVAPS uygulanan hastalarda IPAP değerinin daha yüksek bulunmasına karşılık birinci günde maskeden kaçaklarda iki mod arasında belirgin fark saptanmamıştır.…”

Section: Bulgularunclassified

Comparison of Noninvasive Mechanical Ventilation Volume Assured Pressure Support Mode With Manual Pressure Support in Acute Respiratory Failure of Chronic Obstructive Pulmonary Disease

Rollas¹,

Berktas²,

Berkoğlu³

2012

Solunum

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ÖZETAmaç: Kronik obstrüktif akciğer hastalığına (KOAH) bağlı akut hiperkapnik solunum yetmezliğinin düzeltilmesinde, volüm garantili basınç desteği (average volume assured pressure support: AVAPS) stratejisinin manuel basınç desteği ile, etkinlik ve tolerabilite açısından karşılaştırılmasıdır. ABSTRACTAim: The aim of this study was to compare the efficacy and tolerability of average volume assured pressure support (AVAPS) strategy with the support of manual pressure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Materials and Methods:Thirty-five patients treated for acute hypercapnic respiratory failure due to COPD were included in the study. Ventilation was applied with the same bilevel device respectively, 45 minutes with manual pressure support ventilation, 45 minutes with AVAPS and again 45 minutes with manual pressure support ventilation modes. Between each sequence 60 minutes without noninvasive mechanical ventilation (NIMV) was provided. Thirteen patients with pressure support and 11 patients with AVAPS mode continued the application of NIMV for approximately 24 hours overenight. At the beginning and at the end of each period of NIMV; arterial blood gases, respiratory rates, dyspnea scores (BORG visual analogue scale, 0 = no dyspnea, 10 = severe dyspnea), heart rate, arterial blood pressure, ventilatory parameters (volume, pressure) and mask leaks were recorded.Results: Twenty three of 35 patients included in the study were male and 12 were female. The mean value of body mass index was 27.2±5.6 kg/m 2 . With respect to the initial values of pH and PaCO 2 improvements was observed in each NIMV period (for both values p<0.001), but no difference was found between AVAPS and manuel pressure support (p>0.05). After 24 hour follow-up, in two patients continuing with AVAPS group

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Patient–Ventilator Interaction

Cited by 215 publications

References 78 publications

Different modes of assisted ventilation in patients with acute respiratory failure

Different modes of assisted ventilation in patients with acute respiratory failure

How Often Does Patient-Ventilator Asynchrony Occur and What Are the Consequences?

Comparison of Noninvasive Mechanical Ventilation Volume Assured Pressure Support Mode With Manual Pressure Support in Acute Respiratory Failure of Chronic Obstructive Pulmonary Disease

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