Cycling of the Mechanical Ventilator Breath

Gentile, Michael A.

doi:10.4187/respcare.01088

Cited by 37 publications

(28 citation statements)

References 31 publications

(27 reference statements)

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“…This means that the system continues in the inspiratory phase, once the patient's inspiratory effort has ended, which decreases the time available for the expiratory phase. This may produce an activation of the patient's expiratory muscles before the established cycling criteria (active exhalation), air trapping, dynamic hyperinflation and PEEPi, which may increase the work of breathing and cause ineffective efforts [32][33][34]. Parthasarathy et al mentioned that "a delay in relaxation of the expiratory muscles could cause them to remain active during the early phase of the next inspiration, and by opposing the downward motion of the diaphragm could hinder the efficacy of the subsequent inspiratory effort.…”

Section: Delayed Cyclingmentioning

confidence: 99%

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Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Arellano¹

2017

PMCOA

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A significant percentage of mechanically ventilated patients in Intensive Care Units (ICUs) show some type of patient-ventilator asynchrony (PVA). The presence of PVA is associated with complications that affect the clinical outcome and the goals for which mechanical ventilation is used in critically ill patients. Currently, mechanical ventilators are able to show different types of waveforms that allow to identify the different types of PVA in a noninvasive and reliable way. However, in order to perform an adequate interpretation and management of the PVA the health care professionals must be properly trained in the topic.

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Section: Delayed Cyclingmentioning

confidence: 99%

“…In these cases, an effective solution would be decreasing the inspiratory time in controlled modes such as pressure assist/control ventilation and Synchronized Intermittent Mandatory Ventilation (SIMV) [33,34]. The inspiratory time can be decrease, also, by modifying the cycling criteria in pressure support ventilation [23].…”

Section: Delayed Cyclingmentioning

confidence: 99%

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Arellano¹

2017

PMCOA

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“…[9][10][11] In modern ventilators, cycling can be adjusted. 4 As has been shown for invasive ventilation, adjustment of cycling criteria improves patient ventilator synchronization and reduces intrinsic PEEP. 13,14 However, studies assessing cycling in depth 15 are lacking.…”

Section: Introductionmentioning

confidence: 95%

“…3 Inspiratory pressure assistance decreases during the inspiration and is stopped at a predetermined percentage of peak flow, which is called cycling. 4 When cycling is inefficient, it can cause patientventilator mismatch. Poor patient ventilator synchrony is common and is associated with increased work of breath-ing, discomfort, prolonged mechanical ventilation, and NIV failure.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

et al. 2015

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BACKGROUND: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction. METHODS: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H 2 O) using the ventilator's invasive and NIV mode with and without an applied leakage. RESULTS: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001). CONCLUSION: Augmenting the cycling criterion above the default setting (20 -30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.

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Mechanical Ventilation

Kornecki

Wheeler

2014

Pediatric Critical Care Medicine

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Cycling of the Mechanical Ventilator Breath

Cited by 37 publications

References 31 publications

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

Mechanical Ventilation

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