Pressure support ventilation

2016 ◽  
Author(s):  
Hérnan Aguirre-Bermeo ◽  
Jordi Mancebo
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Closed Loop ◽  
Threshold Level ◽  
Comfort Zone ◽  
Gradual Reduction ◽  
Support Ventilation ◽  
Breathing Effort ◽  
Levels Of Support

Pressure support ventilation (PSV) is one of the most common ventilatory modalities used in intensive care units. PSV is an assisted, pressure-limited, and flow-cycled ventilatory mode. The ventilator provides assistance when the patient makes a breathing effort, and when inspiratory flow reaches a certain threshold level, cycling to exhalation occurs. PSV unloads respiratory muscle effort, while allowing the patient to retain control over the respiratory rate and tidal volume. Withdrawal from mechanical ventilation should be performed with a gradual reduction of levels of support until extubation. Asynchronies can be present during PSV and are typically associated with high levels of support. A closed-loop modality, which adjusts support levels to keep the patient in a ‘comfort zone’, has been designed to assist in the withdrawal of mechanical ventilation. It performs at least as well as experienced medical staff and could be useful in specific groups of patients.

scholarly journals Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Liang-Jun Ou-Yang ◽  
Po-Huang Chen ◽  
Hong-Jie Jhou ◽  
Vincent Yi-Fong Su ◽  
Cho-Hao Lee
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Sequential Analysis ◽  
Pressure Support ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Proportional Assist Ventilation ◽  
Support Ventilation ◽  
Mechanical Ventilation Duration ◽  
Significant Difference

Abstract Background Pressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Whether PAV or PSV is superior for weaning remains unclear. Methods Eligible randomized controlled trials published before April 2020 were retrieved from databases. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). Results Seven articles, involving 634 patients, met the selection criteria. Compared to PSV, PAV was associated with a significantly higher rate of weaning success (fixed-effect RR 1.16; 95% CI 1.07–1.26; I2 = 0.0%; trial sequential analysis-adjusted CI 1.03–1.30), and the trial sequential monitoring boundary for benefit was crossed. Compared to PSV, PAV was associated with a lower proportion of patients requiring reintubation (RR 0.49; 95% CI 0.28–0.87; I2 = 0%), a shorter ICU length of stay (MD − 1.58 (days), 95% CI − 2.68 to − 0.47; I2 = 0%), and a shorter mechanical ventilation duration (MD − 40.26 (hours); 95% CI − 66.67 to − 13.84; I2 = 0%). There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.42–1.06; I2 = 0%) or weaning duration (MD − 0.01 (hours); 95% CI − 1.30–1.28; I2 = 0%). Conclusion The results of the meta-analysis suggest that PAV is superior to PSV in terms of weaning success, and the statistical power is confirmed using trial sequential analysis. Graphical abstract

Mechanical Ventilation Modes

2017 ◽  
Author(s):  
Yuan Lei
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Ventilation Mode ◽  
Support Ventilation ◽  
Ventilation Modes ◽  
Standardized Terminology ◽  
Signature Waveforms ◽  
Shed Light

‘Mechanical Ventilation Modes’ seeks to shed light on this hotly debated topic, one that is complicated by ventilator manufacturers’ non-standardized terminology. The chapter looks at conventional modes, adaptive modes, and biphasic modes, which it classifies based on the mechanical breath types in each mode. It includes a comparison chart of the terminology used for common modes on popular IPPV ventilators. Using their signature waveforms, the author describes the assist/control, SIMV, and pressure support ventilation or PSV modes. It defines the modes by their application of spontaneous breaths and mandatory breaths. It continues with a discussion of adaptive modes and biphasic modes. It ends by discussing how to select the appropriate ventilation mode.

scholarly journals Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

2014 ◽  
Vol 40 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Wagner da Silva Naue ◽  
Luiz Alberto Forgiarini Junior ◽  
Alexandre Simoes Dias ◽  
Silvia Regina Rios Vieira
Keyword(s):  
Mechanical Ventilation ◽  
Chest Compression ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Respiratory Mechanics ◽  
Intervention Group ◽  
Dynamic Compliance ◽  
Control Group ◽  
Porto Alegre ◽  
Support Ventilation

OBJECTIVE: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. METHODS: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. RESULTS: We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005). CONCLUSIONS: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/])

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