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...

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Autores: Rittayamai, N, Beloncle, F, Goligher, EC, Chen, L, Mancebo, J, Richard, JCM, Brochard, L
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p6090
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=6090
Access Level:acceso abierto
Palabra clave:Airway pressure release ventilation
Lung-protective ventilation
Spontaneous ventilation
Transpulmonary pressure
Ventilator-induced lung injury
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spelling Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effortRittayamai, NBeloncle, FGoligher, ECChen, LMancebo, JRichard, JCMBrochard, LAirway pressure release ventilationLung-protective ventilationSpontaneous ventilationTranspulmonary pressureVentilator-induced lung injuryBackground: 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.SPRINGEROPEN2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=6090Annals of Intensive CareISSN: 21105820reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p60902026-06-14T12:41:47Z
dc.title.none.fl_str_mv Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
title Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
spellingShingle Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
Rittayamai, N
Airway pressure release ventilation
Lung-protective ventilation
Spontaneous ventilation
Transpulmonary pressure
Ventilator-induced lung injury
title_short Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
title_full Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
title_fullStr Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
title_full_unstemmed Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
title_sort Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort
dc.creator.none.fl_str_mv Rittayamai, N
Beloncle, F
Goligher, EC
Chen, L
Mancebo, J
Richard, JCM
Brochard, L
author Rittayamai, N
author_facet Rittayamai, N
Beloncle, F
Goligher, EC
Chen, L
Mancebo, J
Richard, JCM
Brochard, L
author_role author
author2 Beloncle, F
Goligher, EC
Chen, L
Mancebo, J
Richard, JCM
Brochard, L
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Airway pressure release ventilation
Lung-protective ventilation
Spontaneous ventilation
Transpulmonary pressure
Ventilator-induced lung injury
topic Airway pressure release ventilation
Lung-protective ventilation
Spontaneous ventilation
Transpulmonary pressure
Ventilator-induced lung injury
description 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.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=6090
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=6090
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGEROPEN
publisher.none.fl_str_mv SPRINGEROPEN
dc.source.none.fl_str_mv Annals of Intensive Care
ISSN: 21105820
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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