The Incidence Of Patient-Ventilator Asynchrony During Weaning From Mechanical Ventilation: A Comparison Of Proportional Assist Ventilation (PAV) To Pressure Support (PS)

Hosking, Brooke; Nikoo, Mohammad; Bosma, Karen J.

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a3197

Cited by 4 publications

(3 citation statements)

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“…compared A/C, PSV, and PAV modes for weaning and found high asynchrony index in 27% of cases in the high PSV group and in 6% in the low PSV group with no cases in the PAV group at its different levels of assist. [13] In studies by Elganady and Xirouchaki et al ., authors found high asynchrony index with PSV as compared to PAV. [1415] They observed mainly ineffective triggering and cyclic dyssynchrony with high asynchrony index in PSV.…”

Section: Discussionmentioning

confidence: 99%

Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

Gautam

Kaur

Katyal

et al. 2016

Indian Journal of Critical Care Medicine

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Background:The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU) patients as a randomized crossover study.Aims:Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+) in surgical patients while weaning.Subjects and Methods:After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV) and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning.Results:Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD]) and 66.50 ± 12.47 (mean ± SD) kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+.Conclusion:Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure assistance modalities are not superior to PSV with respect to cardiorespiratory function.

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Section: Discussionmentioning

confidence: 99%

Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

Gautam

Kaur

Katyal

et al. 2016

Indian Journal of Critical Care Medicine

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“…During breathing, increased effort results in a linear increase in TV. In PSV, the TV is provided after trigger performed by patient and depends on level of support and compliance of respiratory system 14,29,30 . In this study ETV, in PAV+ mode, is directly related to inspiratory effort performed by the simulator.…”

Section: Expired Tidal Volume In Pav+mentioning

confidence: 99%

Performance of proportional assist ventilation plus (PAV+) after being challenged by a mechanical simulator

Matilde

Palazzo

CSV

2022

Preprint

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Background: In assisted mechanical ventilation, the work of breathing (WOB) should be shared by patient and ventilator. In PAV+, there is an association between respiratory muscle pressure and the pressure generated by the ventilator. There are still knowledge deficits about the influence of different types of inspiratory efforts on mechanical ventilator outputs during PAV+ assistance.Methods: A mechanical simulator (ASL-5000 Ingmar Medical®) set with Compliance of 100 mL/cmH20 and resistance of 10 cmH20-L-s) was coupled to the Medtronic 980 (Purittan-Benett ®) mechanical ventilator in the Laboratory of Mechanical Ventilation of INCOR-Faculdade de Medicina Universidade de São Paulo, Brazil. A sequential script of three different inspiratory efforts (-3, -7 and -11 cmH2O) and three different respective inspiratory delays (5%, 15% and 20%), pre-programmed in the ASL5000 simulator software started to run and triggered the ventilator 15 times for each of the 9 sequences, in 19 levels of PAV+ assistance (from 5% to 95%) in a total of 2.565 combinations. The measured outputs from the ventilator were: Expired Tidal Volume (ETV: mL); Inspiratory time (IT: s); Peak inspiratory flow (PIF: cmH20); Peak inspiratory pressure (PP: cmH20); and Work of breathing (WOB) that were recorded in the ASL-5000_ software and analyzed by R software for Windows, version 4.0.5.Results: A exponential significant increase in ETV (from 88.46 mL to 1095.34 mL), IT (from 0.83 to1.64 s), PIF (from 10.88 to 125.53 L/min) and PP (from 7.53 to 33.23 cmH20) were observed with the increase of both inspiratory efforts and PAV+ assistance. This increment was amplified by the addition of 5%, 10% and 15% of inspiratory delays. WOBpt was compensated by PAV+ % of assistance increment as the inspiratory effort increase. Conclusion: PAV+ responded promptly to increments of inspiratory effort and progressive increase of inspiratory assistance. Delaying the inspiratory muscle effort significantly booster PAV+ ` outputs proportionally to inspiratory efforts levels and PAV+ % of assistance.

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“…La VPA es un modo de VMI que busca coordinar las dos bombas ventilatorias, haciendo que el ventilador quede bajo el control central de la respiración del paciente. Es una forma de asistencia ventilatoria parcial sincronizada, en la que el ventilador genera presión en proporción al esfuerzo espontáneo: mientras más esfuerzo hace el paciente, más apoyo brinda el ventilador mecánico 1 . Es decir, el ventilador amplifica el esfuerzo respiratorio espontáneo del paciente, sin haber seleccionado un respaldo de presión, flujo o volumen por parte del operador y se rige bajo el control completo del impulso ventilatorio del paciente para determinar la profundidad y frecuencia de las respiraciones 2 .…”

Section: Metodologíaunclassified

Ventilación proporcional asistida: 10 razones para su uso en el destete de ventilación mecánica

Izquierdo¹,

Guamán-Crespo²,

Frías³

et al. 2021

REIE

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Introducción: La búsqueda de modos ventilatorios que disminuyan los efectos adversos, además de mantener los parámetros de protección alveolar, ha sido tema de investigación continua. La ventilación proporcional asistida (VPA) conserva la función muscular diafragmática, coordinando el esfuerzo respiratorio del paciente y el aporte que brinda el ventilador. Presentamos un resumen de la VPA y 10 razones para su uso en el destete de la ventilación mecánica, incluyendo una comparación con el modo de destete más frecuentemente usado: la ventilación con presión soporte (PSV). Métodos: Realizamos una revisión bibliográfica recogiendo información de PubMed, CINAHL y la Biblioteca Cochrane desde 2001 hasta 2019, para evidenciar los efectos de la VPA en los pacientes ventilados en unidad de cuidados intensivos (UCI). Comparamos VPA vs. PSV como grupo control; observamos que el tiempo de ventilación mecánica invasiva antes de iniciar con el destete fue de 114.98 horas para VPA y 134.56 horas para PSV; destete exitoso en el 88.25 vs. 78.9%, mortalidad en UCI del 6.27 vs. 13.4% y mortalidad hospitalaria del 19.17 vs. 25.72% para los grupos VPA y PSV respectivamente. Discusión y conclusiones: Utilizar VPA es segura para los pacientes, mejora de manera significativa el éxito en la extubación, disminuye el tiempo dependiente de ventilador y la mortalidad.

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The Incidence Of Patient-Ventilator Asynchrony During Weaning From Mechanical Ventilation: A Comparison Of Proportional Assist Ventilation (PAV) To Pressure Support (PS)

Cited by 4 publications

References 0 publications

Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

Performance of proportional assist ventilation plus (PAV+) after being challenged by a mechanical simulator

Ventilación proporcional asistida: 10 razones para su uso en el destete de ventilación mecánica

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