Individual response in patient's effort and driving pressure to variations in assistance during pressure support ventilation
© 2023. The Author(s)..
BACKGROUND: During Pressure Support Ventilation (PSV) an inspiratory hold allows to measure plateau pressure (Pplat), driving pressure (∆P), respiratory system compliance (Crs) and pressure-muscle-index (PMI), an index of inspiratory effort. This study aims [1] to assess systematically how patient's effort (estimated with PMI), ∆P and tidal volume (Vt) change in response to variations in PSV and [2] to confirm the robustness of Crs measurement during PSV.
METHODS: 18 patients recovering from acute respiratory failure and ventilated by PSV were cross-randomized to four steps of assistance above (+ 3 and + 6 cmH2O) and below (-3 and -6 cmH2O) clinically set PS. Inspiratory and expiratory holds were performed to measure Pplat, PMI, ∆P, Vt, Crs, P0.1 and occluded inspiratory airway pressure (Pocc). Electromyography of respiratory muscles was monitored noninvasively from body surface (sEMG).
RESULTS: As PSV was decreased, Pplat (from 20.5 ± 3.3 cmH2O to 16.7 ± 2.9, P < 0.001) and ∆P (from 12.5 ± 2.3 to 8.6 ± 2.3 cmH2O, P < 0.001) decreased much less than peak airway pressure did (from 21.7 ± 3.8 to 9.7 ± 3.8 cmH2O, P < 0.001), given the progressive increase of patient's effort (PMI from -1.2 ± 2.3 to 6.4 ± 3.2 cmH2O) in line with sEMG of the diaphragm (r = 0.614; P < 0.001). As ∆P increased linearly with Vt, Crs did not change through steps (P = 0.119).
CONCLUSION: Patients react to a decrease in PSV by increasing inspiratory effort-as estimated by PMI-keeping Vt and ∆P on a desired value, therefore, limiting the clinician's ability to modulate them. PMI appears a valuable index to assess the point of ventilatory overassistance when patients lose control over Vt like in a pressure-control mode. The measurement of Crs in PSV is constant-likely suggesting reliability-independently from the level of assistance and patient's effort.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Annals of intensive care - 13(2023), 1 vom: 20. Dez., Seite 132 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Docci, Mattia [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory failure |
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| Anmerkungen: |
Date Revised 23.12.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13613-023-01231-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366144146 |
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| 100 | 1 | |a Docci, Mattia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Individual response in patient's effort and driving pressure to variations in assistance during pressure support ventilation |
| 264 | 1 | |c 2023 | |
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| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: During Pressure Support Ventilation (PSV) an inspiratory hold allows to measure plateau pressure (Pplat), driving pressure (∆P), respiratory system compliance (Crs) and pressure-muscle-index (PMI), an index of inspiratory effort. This study aims [1] to assess systematically how patient's effort (estimated with PMI), ∆P and tidal volume (Vt) change in response to variations in PSV and [2] to confirm the robustness of Crs measurement during PSV | ||
| 520 | |a METHODS: 18 patients recovering from acute respiratory failure and ventilated by PSV were cross-randomized to four steps of assistance above (+ 3 and + 6 cmH2O) and below (-3 and -6 cmH2O) clinically set PS. Inspiratory and expiratory holds were performed to measure Pplat, PMI, ∆P, Vt, Crs, P0.1 and occluded inspiratory airway pressure (Pocc). Electromyography of respiratory muscles was monitored noninvasively from body surface (sEMG) | ||
| 520 | |a RESULTS: As PSV was decreased, Pplat (from 20.5 ± 3.3 cmH2O to 16.7 ± 2.9, P < 0.001) and ∆P (from 12.5 ± 2.3 to 8.6 ± 2.3 cmH2O, P < 0.001) decreased much less than peak airway pressure did (from 21.7 ± 3.8 to 9.7 ± 3.8 cmH2O, P < 0.001), given the progressive increase of patient's effort (PMI from -1.2 ± 2.3 to 6.4 ± 3.2 cmH2O) in line with sEMG of the diaphragm (r = 0.614; P < 0.001). As ∆P increased linearly with Vt, Crs did not change through steps (P = 0.119) | ||
| 520 | |a CONCLUSION: Patients react to a decrease in PSV by increasing inspiratory effort-as estimated by PMI-keeping Vt and ∆P on a desired value, therefore, limiting the clinician's ability to modulate them. PMI appears a valuable index to assess the point of ventilatory overassistance when patients lose control over Vt like in a pressure-control mode. The measurement of Crs in PSV is constant-likely suggesting reliability-independently from the level of assistance and patient's effort | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute respiratory failure | |
| 650 | 4 | |a Artificial ventilation | |
| 650 | 4 | |a Breathing effort | |
| 650 | 4 | |a Driving pressure | |
| 650 | 4 | |a Monitoring | |
| 650 | 4 | |a Pressure muscle index | |
| 650 | 4 | |a Pressure support ventilation | |
| 650 | 4 | |a Respiratory system compliance | |
| 700 | 1 | |a Rezoagli, Emanuele |e verfasserin |4 aut | |
| 700 | 1 | |a Teggia-Droghi, Maddalena |e verfasserin |4 aut | |
| 700 | 1 | |a Coppadoro, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Pozzi, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Grassi, Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Bianchi, Isabella |e verfasserin |4 aut | |
| 700 | 1 | |a Foti, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Bellani, Giacomo |e verfasserin |4 aut | |
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