scholarly journals Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation

2021 ◽  
Vol 8 ◽  
Author(s):  
Ling Liu ◽  
Yue Yu ◽  
Xiaoting Xu ◽  
Qin Sun ◽  
Haibo Qiu ◽  
...  
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Inspiratory Effort ◽  
Respiratory Drive ◽  
Breathing Patterns ◽  
Asynchrony Index ◽  
Support Ventilation ◽  
Automatic Adjustment ◽  
Adjustment System ◽  
Improve Patient

Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV.Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS10), 30% (PS30), 50% (PS50), and automatic adjustment PSV (PSAUTO). Patient-ventilator interactions were measured.Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PSAUTO when compared with PS10, PS30, and PS50, (P < 0.05). The benefit of PSAUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PSAUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PSAUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes.Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.

Performance Characteristics of Five New Anesthesia Ventilators and Four Intensive Care Ventilators in Pressure-support Mode

2006 ◽  
Vol 105 (5) ◽  
pp. 944-952 ◽  
Author(s):  
Samir Jaber ◽  
Didier Tassaux ◽  
Mustapha Sebbane ◽  
Yvan Pouzeratte ◽  
Anne Battisti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pressure Support Ventilation ◽  
Gas Flow ◽  
Pressure Support ◽  
Inspiratory Effort ◽  
Performance Characteristics ◽  
Lung Model ◽  
Support Ventilation ◽  
Ventilation Performance

Background During the past few years, many manufacturers have introduced new modes of ventilation in anesthesia ventilators, especially partial-pressure modalities. The current bench test study was designed to compare triggering and pressurization of five new anesthesia ventilators with four intensive care unit ventilators. Methods Ventilators were connected to a two-compartment lung model. One compartment was driven by an intensive care unit ventilator to mimic "patient" inspiratory effort, whereas the other was connected to the tested ventilator. The settings of ventilators were positive end-expiratory pressures of 0 and 5 cm H2O, and pressure-support ventilation levels of 10, 15, and 20 cm H2O with normal and high "patient" inspiratory effort. For the anesthesia ventilators, all the measurements were obtained for a low (1 l/min) and a high (10 l/min) fresh gas flow. Triggering delay, triggering workload, and pressurization at 300 and 500 ms were analyzed. Results For the five tested anesthesia ventilators, the pressure-support ventilation modality functioned correctly. For inspiratory triggering, the three most recent anesthesia machines (Fabius, Drägerwerk AG, Lübeck, Germany; Primus, Drägerwerk AG; and Avance, GE-Datex-Ohemda, Munchen, Germany) had a triggering delay of less than 100 ms, which is considered clinically satisfactory and is comparable to intensive care unit machines. The use of positive end-expiratory pressure modified the quality of delivered pressure support for two anesthesia ventilators (Kion, Siemens AG, Munich, Germany; and Felix, Taema, Antony, France). Three of the five anesthesia ventilators exhibited pressure-support ventilation performance characteristics comparable to those of the intensive care unit machines. Increasing fresh gas flow (1 to 10 l/min) in the internal circuit did not influence the pressure-support ventilation performance of the anesthesia ventilators. Conclusion Regarding trigger sensitivity and the system's ability to meet inspiratory flow during pressure-supported breaths, the most recent anesthesia ventilators have comparable performances of recent-generation intensive care unit ventilators.

scholarly journals Effect of the pressure ramp on the breathing pattern and respiratory drive in pressure support ventilation

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P305
Author(s):  
A Tejero Pedregosa ◽  
F Ruiz Ferrón ◽  
MI Ruiz García ◽  
S Galindo Rodríguez ◽  
A Morante Valle ◽  
...  
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Breathing Pattern ◽  
Respiratory Drive ◽  
Support Ventilation

scholarly journals Refractory ineffective triggering during pressure support ventilation: effect of proportional assist ventilation with load-adjustable gain factors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Fleur Haudebourg ◽  
Tommaso Maraffi ◽  
Samuel Tuffet ◽  
François Perier ◽  
Nicolas de Prost ◽  
...  
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Esophageal Pressure ◽  
Physiological Study ◽  
Observational Assessment ◽  
Proportional Assist Ventilation ◽  
Asynchrony Index ◽  
Support Ventilation ◽  
Academic Medical ◽  
The Impact

Abstract Background Ineffective triggering is frequent during pressure support ventilation (PSV) and may persist despite ventilator adjustment, leading to refractory asynchrony. We aimed to assess the effect of proportional assist ventilation with load-adjustable gain factors (PAV+) on the occurrence of refractory ineffective triggering. Design Observational assessment followed by prospective cross-over physiological study. Setting Academic medical ICU. Patients Ineffective triggering was detected during PSV by a twice-daily inspection of the ventilator’s screen. The impact of pressure support level (PSL) adjustments on the occurrence of asynchrony was recorded. Patients experiencing refractory ineffective triggering, defined as persisting asynchrony at the lowest tolerated PSL, were included in the physiological study. Interventions Physiological study: Flow, airway, and esophageal pressures were continuously recorded during 10 min under PSV with the lowest tolerated PSL, and then under PAV+ with the gain adjusted to target a muscle pressure between 5 and 10 cmH2O. Measurements Primary endpoint was the comparison of asynchrony index between PSV and PAV+ after PSL and gain adjustments. Results Among 36 patients identified having ineffective triggering under PSV, 21 (58%) exhibited refractory ineffective triggering. The lowest tolerated PSL was higher in patients with refractory asynchrony as compared to patients with non-refractory ineffective triggering. Twelve out of the 21 patients with refractory ineffective triggering were included in the physiological study. The median lowest tolerated PSL was 17 cmH2O [12–18] with a PEEP of 7 cmH2O [5–8] and FiO2 of 40% [39–42]. The median gain during PAV+ was 73% [65–80]. The asynchrony index was significantly lower during PAV+ than PSV (2.7% [1.0–5.4] vs. 22.7% [10.3–40.1], p < 0.001) and consistently decreased in every patient with PAV+. Esophageal pressure–time product (PTPes) did not significantly differ between the two modes (107 cmH2O/s/min [79–131] under PSV vs. 149 cmH2O/s/min [129–170] under PAV+, p = 0.092), but the proportion of PTPes lost in ineffective triggering was significantly lower with PAV+ (2 cmH2O/s/min [1–6] vs. 8 cmH2O/s/min [3–30], p = 0.012). Conclusions Among patients with ineffective triggering under PSV, PSL adjustment failed to eliminate asynchrony in 58% of them (21 of 36 patients). In these patients with refractory ineffective triggering, switching from PSV to PAV+ significantly reduced or even suppressed the incidence of asynchrony.

Closed-Loop Control of Respiratory Drive Using Pressure-Support Ventilation

2005 ◽  
Vol 171 (9) ◽  
pp. 1009-1014 ◽  
Author(s):  
Jadranka Spahija ◽  
Jennifer Beck ◽  
Michel de Marchie ◽  
Alain Comtois ◽  
Christer Sinderby
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Closed Loop ◽  
Closed Loop Control ◽  
Respiratory Drive ◽  
Loop Control ◽  
Support Ventilation

Respiratory response and inspiratory effort during pressure support ventilation in COPD patients

1995 ◽  
Vol 21 (11) ◽  
pp. 871-879 ◽  
Author(s):  
S. Nava ◽  
C. Bruschi ◽  
F. Rubini ◽  
A. Palo ◽  
G. Iotti ◽  
...  
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Inspiratory Effort ◽  
Respiratory Response ◽  
Support Ventilation ◽  
Copd Patients

scholarly journals Flow Index: a novel, non-invasive, continuous, quantitative method to evaluate patient inspiratory effort during pressure support ventilation

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Filippo Albani ◽  
Luigi Pisani ◽  
Gianni Ciabatti ◽  
Federica Fusina ◽  
Barbara Buizza ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Pressure Support Ventilation ◽  
Quantitative Method ◽  
Pressure Support ◽  
Esophageal Pressure ◽  
Inspiratory Effort ◽  
Inspiratory Flow ◽  
Flow Index ◽  
Support Ventilation ◽  
Non Invasive

Abstract Background The evaluation of patient effort is pivotal during pressure support ventilation, but a non-invasive, continuous, quantitative method to assess patient inspiratory effort is still lacking. We hypothesized that the concavity of the inspiratory flow-time waveform could be useful to estimate patient’s inspiratory effort. The purpose of this study was to assess whether the shape of the inspiratory flow, as quantified by a numeric indicator, could be associated with inspiratory effort during pressure support ventilation. Methods Twenty-four patients in pressure support ventilation were enrolled. A mathematical relationship describing the decay pattern of the inspiratory flow profile was developed. The parameter hypothesized to estimate effort was named Flow Index. Esophageal pressure, airway pressure, airflow, and volume waveforms were recorded at three support levels (maximum, minimum and baseline). The association between Flow Index and reference measures of patient effort (pressure time product and pressure generated by respiratory muscles) was evaluated using linear mixed effects models adjusted for tidal volume, respiratory rate and respiratory rate/tidal volume. Results Flow Index was different at the three pressure support levels and all group comparisons were statistically significant. In all tested models, Flow Index was independently associated with patient effort (p < 0.001). Flow Index prediction of inspiratory effort agreed with esophageal pressure-based methods. Conclusions Flow Index is associated with patient inspiratory effort during pressure support ventilation, and may provide potentially useful information for setting inspiratory support and monitoring patient-ventilator interactions.

scholarly journals Effects of Different Levels of Pressure Support Variability in Experimental Lung Injury

2009 ◽  
Vol 110 (2) ◽  
pp. 342-350 ◽  
Author(s):  
Peter M. Spieth ◽  
Alysson R. Carvalho ◽  
Andreas Güldner ◽  
Paolo Pelosi ◽  
Oleg Kirichuk ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Pressure Support Ventilation ◽  
Airway Pressure ◽  
Pressure Support ◽  
Inspiratory Effort ◽  
Peak Airway Pressure ◽  
Support Ventilation ◽  
Different Levels ◽  
Surfactant Depletion

Background Noisy pressure support ventilation has been reported to improve respiratory function compared to conventional assisted mechanical ventilation. We aimed at determining the optimal level of pressure support variability during noisy pressure support ventilation. Methods Twelve pigs were anesthetized and mechanically ventilated. Acute lung injury was induced by surfactant depletion. At four levels of pressure support variability (coefficients of variation of pressure support equal to 7.5, 15, 30, and 45%, 30 min each, crossover design, special Latin squares sequence), we measured respiratory variables, gas exchange, hemodynamics, inspiratory effort, and comfort of breathing. The mean level of tidal volume was constant among variability levels. Results Compared to conventional pressure support ventilation, different levels of variability in pressure support improved the elastance of the respiratory system, peak airway pressure, oxygenation, and intrapulmonary shunt. Oxygenation and venous admixture benefited more from intermediate (30%) levels of variability, whereas elastance and peak airway pressure improved linearly with increasing variability. Heart rate as well as mean arterial and pulmonary arterial pressures decreased slightly at intermediate to high (30-45%) levels of variability in pressure support. Inspiratory effort and comfort of breathing were not importantly influenced by increased variability in pressure support. Conclusion In a surfactant depletion model of acute lung injury, variability of pressure support improves lung function. The variability level of 30% seems to represent a reasonable compromise to improve lung functional variables during noisy pressure support ventilation.

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