Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort - 08/01/26
, François Beloncle 1, 2, 4 , Ewan C. Goligher 1, 5, 6, 7 , Lu Chen 1, 2 , Jordi Mancebo 8, 9 , Jean-Christophe M. Richard 10, 11 , Laurent Brochard 1, 2
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Abstract |
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, PTP es ), 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 PTP es was significantly higher in PC-IMV (215.6 ± 154.3 vs 150.0 ± 102.4 vs 130.9 ± 101.8 cmH 2 O × s × min −1 , respectively; p < 0.05), with no differences in gas exchange and hemodynamic variables. PTP es 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 PTP es .
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.
Clinical Trial Registration Clinicaltrial.gov # NCT02071277
Le texte complet de cet article est disponible en PDF.Keywords : Airway pressure release ventilation, Lung-protective ventilation, Spontaneous ventilation, Transpulmonary pressure, Ventilator-induced lung injury
Plan
Vol 7 - N° 1
Article 100- 2017 Retour au numéro
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