Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury

Chiumello, Davide; Pelosi, Paolo; Taccone, Paolo; Slutsky, Arthur S.; Gattinoni, Luciano

doi:10.1097/01.ccm.0000089939.11032.36

Cited by 83 publications

(56 citation statements)

References 24 publications

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“…At f 30 and f 40 , the helmet had a shorter mechanical T I than the ETT and face mask (P Ͻ .01), whereas at f 50 , the face mask had the longest mechanical T I compared with the ETT and helmet (P Ͻ .05).…”

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 95%

“…At f 30 and f 40 , the helmet presented the shortest mechanical T I /T tot compared with the ETT and face mask (P Ͻ .05), but at f 50 , the face mask had a shorter ratio than the other interfaces (P Ͻ .01).…”

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

“…At f 30 and f 40 , the face mask had the highest neural V T /mechanical V T compared with the ETT and helmet (P Ͻ .01). At f 50 during Time press50% /Tr exp25% , no difference was found among the tested interfaces, whereas at Time press80% /Tr exp60% , the helmet showed the lowest neural V T /mechanical V T (P Ͻ .01).…”

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

“…1). At f 30 , with each ventilator setting, and at f 50 and Time press50% /Tr exp25% , the ETT had a shorter T press than face mask and helmet (P Ͻ .01). At f 40 at Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% , the helmet had the shortest T press (P Ͻ .01).…”

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

See 3 more Smart Citations

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

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BACKGROUND: In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. METHODS: A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Time press ] 50% /cycling-off flow threshold [Tr exp ] 25% , Time press80% /Tr exp60% ), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. RESULTS: At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f 30 , the ETT had a reduced T press . The helmet had the shortest T press in the simulated child with a mixed obstructive and restricted respiratory condition, at f 40 during Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% . In the simulated child with a normal respiratory condition, the ETT presented the shortest T press value at f 50 during Time press80% /Tr exp60% . Concerning the expiratory trigger delay, the helmet showed the best interaction at f 30 , but the worst at f 40 and at f 50 . The helmet showed the shortest time of synchrony during all ventilator settings. CONCLUSIONS: The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The helmet demonstrated the worst interaction, suggesting that the face mask should be considered as the first choice for delivering noninvasive ventilation in a pediatric model.

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Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 95%

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

Section: Pediatric Model With a Mixed Obstructive And Restricted Respmentioning

confidence: 99%

See 2 more Smart Citations

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

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show abstract

“…14,15 Cycle criteria are also expected to influence inspiratory duration and may possibly decrease LI-RAP. 8,14,15 Our simulation study revealed that changes in cycle criteria could affect the duration and magnitude of LIRAP in various lung models but could abolish LIRAP only in restrictive lung model when inspiratory effort is medium to high. lung model only.…”

Section: Discussionmentioning

confidence: 99%

Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation

Lin

et al. 2014

Respir Care

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BACKGROUND: Late inspiratory rise in airway pressure (LIRAP, P aw /⌬T) caused by inspiratory muscle relaxation or expiratory muscle contraction is frequently seen during pressure support ventilation (PSV), although the modulating factors are unknown. METHODS: We investigated the effects of respiratory mechanics (normal, obstructive, restrictive, or mixed), inspiratory effort (؊2, ؊8, or ؊15 cm H 2 O), flow cycle criteria (5-40% peak inspiratory flow), and duration of inspiratory muscle relaxation (0.18 -0.3 s) on LIRAP during PSV using a lung simulator and 4 types of ventilators. RESULTS: LIRAP occurred with all lung models when inspiratory effort was medium to high and duration of inspiratory muscle relaxation was short. The normal lung model was associated with the fastest LIRAP, whereas the obstructive lung model was associated with the slowest. Unless lung mechanics were normal or mixed, LIRAP was unlikely to occur when inspiratory effort was low. Different ventilators were also associated with differences in LIRAP speed. Except for within the restrictive lung model, changes in flow cycle level did not abolish LIRAP if inspiratory effort was medium to high. Increased duration of inspiratory relaxation also led to the elimination of LIRAP. Simulation of expiratory muscle contraction revealed that LIRAP occurred only when expiratory muscle contraction occurred sometime after the beginning of inspiration. CONCLUSIONS: Our simulation study reveals that both respiratory resistance and compliance may affect LIRAP. Except for under restrictive lung conditions, LIRAP is unlikely to be abolished by simply lowering flow cycle criteria when inspiratory effort is strong and relaxation time is rapid. LIRAP may be caused by expiratory muscle contraction when it occurs during inspiration. Key words: patient-ventilator asynchrony; pressure support ventilation; late inspiratory rise in airway pressure. [Respir Care 2015;60(2):201-209.

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Non-invasive Respiratory Support in Pre-term Neonates and Pediatric Patients with Respiratory Failure

Pelosi

Chidini²,

Calderini³

2006

Intensive Care Medicine

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Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury

Cited by 83 publications

References 24 publications

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation

Non-invasive Respiratory Support in Pre-term Neonates and Pediatric Patients with Respiratory Failure

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