Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive pulmonary disease.

Jubran, Amal; Graaff, W. B. Van de; Tobin, Michael

doi:10.1164/ajrccm.152.1.7599811

Cited by 279 publications

(125 citation statements)

References 0 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…The purpose of this part of the study was to establish whether or not during prolonged PPV-assisted walking respiratory muscle recruitment would reach the levels observed during free walking; as shown in table 3, this did not occur. This observation argues against the concept that exercise limitation in this context occurs as a result of a failure of the patient/ventilator interaction [29] and instead points to a physiological process. This could either be failure of the inspiratory muscle pump; this seems implausible since no trend for PTPoes or PTPdi to fall during PPV exhaustive exercise was observed.…”

Section: Significance Of the Findingsmentioning

confidence: 79%

Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support

Kyroussis¹,

Polkey²,

Hamnegärd³

et al. 2000

Eur Respir J

117

View full text Add to dashboard Cite

The function of the diaphragm and other respiratory muscles during exercise in chronic obstructive pulmonary disease (COPD) remains controversial and few data exist regarding respiratory muscle pressure generation in this situation.The inspiratory pressure/time products of the oesophageal and transdiaphragmatic pressure, and the expiratory gastric pressure/time product during exhaustive treadmill walking in 12 patients with severe COPD are reported. The effect of noninvasive positive pressure ventilation during treadmill exercise was also examined in a subgroup of patients (n=6).During free walking, the inspiratory pressure/time products rose early in the walk and then remained level until the patients were forced to stop because of intolerable dyspnoea. In contrast, the expiratory gastric pressure/time product increased progressively throughout the walk. When patients walked the same distance assisted by noninvasive positive pressure ventilation, a substantial reduction was observed in the inspiratory and expiratory pressure/time products throughout the walk. When patients walked with positive pressure ventilation for as long as they could, the pressure/time products observed at exercise cessation were lower than those observed during exercise cessation after free walking.It is concluded that, in severe chronic obstructive pulmonary disease, inspiratory muscle pressure generation does not increase to meet the demands imposed by exhaustive exercise, whereas expiratory muscle pressure generation rises progressively. Inspiratory pressure support was shown to substantially unload all components of the respiratory muscle pump. Eur Respir J 2000; 15: 649±655.

show abstract

Section: Significance Of the Findingsmentioning

confidence: 79%

Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support

Kyroussis¹,

Polkey²,

Hamnegärd³

et al. 2000

Eur Respir J

117

View full text Add to dashboard Cite

show abstract

“…Pressure support levels were set between 5 and 10 cmH 2 O in studies of weaning with PSV; such levels were suggested to be effective in overcoming the resistance and workload of endotracheal tube and respiratory circuits [26,[34][35][36][37]. SULZER et al [9] decreased minute volume to 25% of the baseline value in cardiac surgery patients and achieved extubation with this level of support.…”

Section: Weaning Protocols and Settingsmentioning

confidence: 99%

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

et al. 2011

View full text Add to dashboard Cite

Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV.From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode.Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p50.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant.This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

show abstract

“…It has also been shown that at high levels of PSV many COPD patients show expiratory muscle activation during the inflation phase [32], indicating that the patient may be fighting the ventilator. In the present study this recruitment was recorded by the so-called expiratory increase in Pga, which has been shown to correlate with transversus abdominis EMG activity [17].…”

Section: Diaphragm Function and Breathing Patternmentioning

confidence: 99%

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

et al. 2004

View full text Add to dashboard Cite

The aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients9 breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage.A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate.No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients9 tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate.In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance.

show abstract

Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive pulmonary disease.

Cited by 279 publications

References 0 publications

Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support

Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

Contact Info

Product

Resources

About