Automation of expiratory trigger sensitivity in pressure support ventilation

Hl, Du Mont; Mb, Amato; Yamada, Yasufumi

doi:10.1016/s1078-5337(05)70046-0

Cited by 22 publications

(13 citation statements)

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“…However, the dispersion of delays in PCV and PSV reflects that the cycling off is dependent on conditions that are varying cycle by cycle. These varying parameters include patient inspiratory effort, neural inspiratory and expiratory time, the level of assist, the time constant of the Articles NAVA in infants respiratory system, and the level of end-expiratory lung volume (22,23). Up to one-fifth of the breaths during conventional ventilation showed cycling off before the peak of the Edi.…”

Section: Nava In Infantsmentioning

confidence: 99%

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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Background: Neurally adjusted ventilatory assist (NaVa) is a mode of ventilation controlled by the electrical activity of the diaphragm (edi). The aim was to evaluate patient-ventilator interaction in infants during NaVa as compared with conventional ventilation. Methods: Infants were successively ventilated with NaVa, pressure control ventilation (PcV), and pressure support ventilation (PsV). edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation. results: Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PcV and PsV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NaVa. Trigger delays were shorter with NaVa as compared with PcV and PsV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PcV and PsV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NaVa). During PcV and PsV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NaVa. a large variability was observed for edi in all modes, which was transmitted into Pvent during NaVa (coefficient of variation: 24 ± 8%) and not in PcV (coefficient of variation 2 ± 1%) or PsV (2 ± 2%). conclusion: NaVa improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.c onventional modes of mechanical ventilation are clearly limited in their ability to provide synchrony between the patient and the assist delivered, as demonstrated repeatedly in adults (1,2) and more recently in children (3). Patientventilator asynchrony has been associated with poor clinical outcome (1,2,4). Despite the attempt to improve synchrony with "patient-triggered" modes such as pressure control ventilation (PCV) or pressure support ventilation (PSV), 25% of adult patients show more than 10% asynchrony with the ventilator (1,2,5). In pediatric patients, synchrony is particularly difficult to achieve because of the small tidal volumes, high respiratory rates, and weak airway flows and pressures. Ironically, during synchronized intermittent mandatory ventilation, more than half of the patient's breathing cycle is spent in asynchrony (3) with the ventilator.Besides the poor timing between the patient and the ventilator, patient-ventilator asynchrony also includes the inability of the ventilator to respond to patient demand and the natural breath-to-breath variability. Respiratory variability is a sign of a well functioning respiratory system (6). By definition, PCV and PSV deliver fixed levels of assist, thereby offering no possibility to respond to the patient's respiratory demand and variability.Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers assist in time and in proportion to the electrical activity of the diaphragm (Edi) on a breath-by-breath basis (7). Numerous studies have shown that NAVA efficiently unloads the respirat...

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Section: Nava In Infantsmentioning

confidence: 99%

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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“…[9][10][11][12][13][14][15][16] The reason for multiple studies of flow cycling is attributed to the universal adoption of spontaneous breathing modes such as pressure-support ventilation (PSV). 17 During PSV the patient both triggers and cycles the breath (Fig.…”

Section: Flow Cyclingmentioning

confidence: 99%

“…Advanced software designed to eliminate expiratory asynchrony during PSV has been described by Du et al, 15 and is based on a mathematical model that automatically adjusts the flow-cycling threshold based on data from previous breaths. 12 …”

Section: Flow Cyclingmentioning

confidence: 99%

Cycling of the Mechanical Ventilator Breath

Gentile

2011

Respir Care

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“…While this system appears to have advantages, there are few clinical studies to support automated determination of cycle criteria, compared to either a fixed or clinician-adjustable cycle criteria. [41][42][43] The impact of each of these phases of ventilator operation are covered in detail in subsequent conference papers.…”

Section: Cyclingmentioning

confidence: 99%

Patient-Ventilator Interaction: The Last 40 Years

Branson

2011

Respir Care

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SummaryPatient-ventilator synchrony is a complex issue affected by ventilator performance, patient characteristics, and the patient-ventilator interface. The history of patient-ventilator interaction includes avoidance of pharmacalogic paralysis, the development of spontaneous breathing systems, microprocessor technology to maximize interaction, and closed-loop control. While most clinicians agree that patientventilator synchrony is desirable, there remain no cause-and-effect data that asynchrony is associated with poor outcome.

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Automation of expiratory trigger sensitivity in pressure support ventilation

Cited by 22 publications

References 0 publications

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Cycling of the Mechanical Ventilator Breath

Patient-Ventilator Interaction: The Last 40 Years

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