scholarly journals Comparisons of Metabolic Load between Adaptive Support Ventilation and Pressure Support Ventilation in Mechanically Ventilated ICU Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yen-Huey Chen ◽  
Hsiu-Feng Hsiao ◽  
Hui-Wen Hsu ◽  
Hsiu-Ying Cho ◽  
Chung-Chi Huang
Keyword(s):  
Critical Illness ◽  
Critically Ill Patients ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Minute Volume ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Full Support ◽  
Metabolic Load ◽  
Adaptive Support

Purpose. The aim of this study was to compare the metabolic load between adaptive support ventilation (ASV) and pressure support ventilation (PSV) modes in critically ill patients. Methods. Sequential 20 min ventilation by PSV followed by 20 min ASV in critically ill patients was assessed. ASV was set for full support, i.e., with the minute volume control set at the same level as the minute volume observed during PSV. The trial started from PSV 8 cmH2O and continued with high (PSV 12 cmH2O) to low (PSV 0) conditions or low to high conditions, in random order. The oxygen consumption (VO2), production of carbon dioxide (VCO2), and energy expenditure (EE) were measured by indirect calorimetry (IC). Results. Twenty-four patients with critical illness participated in the study. Comparing with the PSV mode, the EE in the ASV mode was lower in the level of PSV 0 cmH2O (1069 ± 73 vs. 1425 ± 76 kcal), PS 8 cmH2O (1116 ± 70 vs. 1284 ± 61 kcal), and PS 12 cmH2O (1017 ± 70 vs. 1169 ± 58 kcal) (p<0.05). The VO2, VCO2, and P0.1 in PSV were significantly higher than those in ASV (p<0.05). Conclusion. In patients with critical illness, the application of ASV set for full support was associated with a lower metabolic load and respiratory drive than in any of the studied PSV conditions.

scholarly journals Continuous assessment of neuro-ventilatory drive during 12 hours of pressure support ventilation in critically ill patients 

2020 ◽  
Author(s):  
Rosa Di Mussi ◽  
Savino Spadaro ◽  
Carlo Alberto Volta ◽  
Nicola Bartolomeo ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Breathing Pattern ◽  
Continuous Assessment ◽  
Support Ventilation ◽  
Pressure Time ◽  
Ventilatory Drive ◽  
Patient At Risk

Abstract Introduction: Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 hours the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV. Method: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdiPEAK), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTPDI/b and PTPDI/min, respectively), breathing pattern and major asynchronies were continuously monitored for 12 hours (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5 - 15 mV), “Low” (EAdiPEAK < 5 mV) and “High” (EAdiPEAK >15 mV) neuro-ventilatory drive. Results: Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdiPEAK, was “Low” in 50.116 breath (28 %), “Normal” in 88.419 breaths (50 %) and “High” in 38.582 breaths (22 %). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0,55 hours, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than one hour, median 6.1 [3.9 - 8.5] hours and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2 – 7.8] hours. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts. Conclusions: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 hours of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.

scholarly journals Adaptive Support and Pressure Support Ventilation Behavior in Response to Increased Ventilatory Demand

2009 ◽  
Vol 110 (3) ◽  
pp. 620-627 ◽  
Author(s):  
Samir Jaber ◽  
Mustapha Sebbane ◽  
Daniel Verzilli ◽  
Stefan Matecki ◽  
Marc Wysocki ◽  
...  
Keyword(s):  
Dead Space ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Pressure Level ◽  
Control Mode ◽  
Respiratory Effort ◽  
Support Ventilation ◽  
Arterial Blood ◽  
Adaptive Support

Background Dual-control modes of ventilation adapt the pressure delivery to keep a volume target in response to changes in respiratory mechanics, but they may respond poorly to changes in ventilatory demand. Adaptive support ventilation (ASV), a complex minute volume-targeted pressure-regulated ventilation, was compared to adaptive pressure ventilation (APV), a dual-mode in which the pressure level is adjusted to deliver a preset tidal volume, and to pressure support ventilation (PSV) when facing an increase in ventilatory demand. Methods A total of 14 intensive care unit patients being weaned off mechanical ventilation were included in this randomized crossover study. The effect of adding a heat-and-moisture exchanger to augment circuit dead space was assessed with a same fixed level of ASV, PSV, and APV. Results Arterial blood gases, ventilator response, and patient respiratory effort parameters were evaluated at the end of the six periods. Adding dead space significantly increased minute ventilation and PaCO2 values with the three modes. Indexes of respiratory effort (pressure-time index of respiratory muscles and work of breathing) increased with all ventilatory modes after dead-space augmentation. This increase was significantly greater with APV than with PSV or ASV (P &lt; 0.05). The assistance delivered during APV decreased significantly with dead-space from 12.7 +/- 2.6 to 6.7 +/- 1.4 cm H2O, whereas no change occurred with ASV and PSV. Conclusions ASV and PSV behaved differently but ended up with similar pressure level facing acute changes in ventilatory demand, by contrast to APV (a simple volume-guaranteed pressure-control mode), in which an increase in ventilatory demand results in a decrease in the pressure support provided by the ventilator.

scholarly journals Continuous assessment of neuro-ventilatory drive during 12 hours of pressure support ventilation in critically ill patients

2020 ◽  
Author(s):  
Rosa Di Mussi ◽  
Savino Spadaro ◽  
Carlo Alberto Volta ◽  
Nicola Bartolomeo ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Breathing Pattern ◽  
Continuous Assessment ◽  
Support Ventilation ◽  
Pressure Time ◽  
Ventilatory Drive ◽  
Patient At Risk

Abstract Introduction: Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 hours the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV.Method: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdiPEAK), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTPDI/b and PTPDI/min, respectively), breathing pattern and major asynchronies were continuously monitored for 12 hours (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5 - 15 mV), “Low” (EAdiPEAK < 5 mV) and “High” (EAdiPEAK >15 mV) neuro-ventilatory drive.Results: Within all the analyzed breaths (177.117), the neuro-ventilatory drive as expressed by the EAdiPEAK, was “low” (<5 mV) in 50.116 breath (28 %), Normal (5-15 mV) in 88.419 breaths (50 %) and High (>15 mV) in 38.582 breaths (22 %). The average times spent in “Low”, “Normal” and “High” class were 1.37 hours, 3.67 hours and 0,55 hours, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than one hour, median 6.1 [3.9 - 8.5] hours and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2 – 7.8] hours. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts.Conclusions: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 hours of PSV in critically ill patients. Our data suggest that PSV might result in periods of over or under-assistance. Further studies are needed to assess the possible clinical implications of these physiological findings.

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