Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
Background: In pressure-controlled (PC) ventilation, tidal volume (V-T) and transpulmonary pressure (P-L) result from the addition of ventilator pressure and the patient's inspiratory effort. PC modes can be classified into fully, partially, and non-synchronized modes, and the degree of synchro...
| Authors: | , , , , , , |
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| Format: | article |
| Status: | Published version |
| Publication Date: | 2017 |
| Country: | España |
| Institution: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repository: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p6090 |
| Online Access: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=6090 |
| Access Level: | Open access |
| Keyword: | Airway pressure release ventilation Lung-protective ventilation Spontaneous ventilation Transpulmonary pressure Ventilator-induced lung injury |
| Summary: | Background: In pressure-controlled (PC) ventilation, tidal volume (V-T) and transpulmonary pressure (P-L) result from the addition of ventilator pressure and the patient's inspiratory effort. PC modes can be classified into fully, partially, and non-synchronized modes, and the degree of synchronization may result in different V-T and P-L despite identical ventilator settings. This study assessed the effects of three PC modes on V-T, P-L, inspiratory effort (esophageal pressure-time product, PTPes), and airway occlusion pressure, P-0.1. We also assessed whether P-0.1 can be used for evaluating patient effort. Methods: Prospective, randomized, crossover physiologic study performed in 14 spontaneously breathing mechanically ventilated patients recovering from acute respiratory failure (1 subsequently withdrew). PC modes were fully (PC-CMV), partially (PC-SIMV), and non-synchronized (PC-IMV using airway pressure release ventilation) and were applied randomly; driving pressure, inspiratory time, and set respiratory rate being similar for all modes. Airway, esophageal pressure, P-0.1, airflow, gas exchange, and hemodynamics were recorded. Results: V-T was significantly lower during PC-IMV as compared with PC-SIMV and PC-CMV (387 +/- 105 vs 458 +/- 134 vs 482 +/- 108 mL, respectively; p < 0.05). Maximal P-L was also significantly lower (13.3 +/- 4.9 vs 15.3 +/- 5.7 vs 15.5 +/- 5.2 cmH(2)O, respectively; p < 0.05), but PTPes was significantly higher in PC-IMV (215.6 +/- 154.3 vs 150.0 +/- 102.4 vs 130.9 +/- 101.8 cmH(2)O x s x min(-1), respectively; p < 0.05), with no differences in gas exchange and hemodynamic variables. PTPes increased by more than 15% in 10 patients and by more than 50% in 5 patients. An increased P-0.1 could identify high levels of PTPes. Conclusions: Non-synchronized PC mode lowers V-T and P-L in comparison with more synchronized modes in spontaneously breathing patients but can increase patient effort and may need specific adjustments. |
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