ISSN:
1432-1238
Keywords:
Pressure support ventilation
;
Respiratory mechanics
;
Work of breathing
;
Weaning
;
Mechanical ventilation
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective To compare the effects of pressure support ventilation (PSV) delivered at the same level by three different ventilators on patients' work of breathing (WOB), breathing pattern and gas exchange. Design Prospective, self-controlled clinical study. Setting Intensive care unit of a tertiary university hospital. Patients Nine intubated adult patients during weaning from mechanical ventilation. Interventions Patients were randomly connected to one of three ventilators: the Siemens Servo 900 C (SC), the Ohmeda CPU 1 (CPU), and the Engström Erica (EE) during both zero cmH2O PSV and 15 cmH2O PSV. Measurements and results During zero PSV, there was no significant difference in terms of WOB, VT, VE, or auto-PEEP among the three ventilators, although there was a trend towards higher levels of WOB with EE. During 15 cmH2O PSV, WOB was significantly less with SC than with EE or CPU (0.47±0.48 J/l for SC, 1.0±0.48 for EE and 0.78±0.51 for CPU 1,p=0.003). WOB was 64% less than at zero PSV with SC but only 38% less with EE. This was associated with a different pressurization shape, as assessed by the interior surface of Paw-VT loops (1.23±0.09 J/l for SC, 0.9±0.02 for EE, and 0.79±0.18 for CPU;p〈0.001). At 15 cmH2O PSV, auto-PEEP was significantly lower with SC than with EE (1.7±2.1 cmH2O for SC, 4.7±3.6 for EE, and 2.8±0.3 for CPU;p=0.04). External expiratory resistances, in cmH2O/l/s, were significantly higher with EE than with CPU or SC (12.9±3.2 EE, 7.5±2.4 CPU, 5.9±0.5 SC;p〈0.001). Conclusion During PSV, the different working principles of different mechanical ventilators profoundly affect patient's WOB. Among the various factors, velocity of pressurization of PSV may play a role in its efficacy in unloading the respiratory muscles.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01712332
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