Effect of varying the pressurisation rate during noninvasive pressure support ventilation

Prinianakis, George; Delmastro, Monica; Carlucci, Annalisa; Ceriana, Piero; Nava, Stefano

doi:10.1183/09031936.03.00010203

Cited by 60 publications

(26 citation statements)

References 33 publications

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“…Our results are in accordance with those reported in adults by Prinianakis et al 29 They evaluated the effects of variable pressuriza- tion rates on patient's breathing pattern, inspiratory effort, and arterial blood gases in a group of patients with COPD receiving PSV through a face mask. Faster pressurization rates resulted in a reduction of pressure-time product of the diaphragm.…”

Section: Discussionsupporting

confidence: 83%

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: Discussionsupporting

confidence: 83%

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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“…The ramp was determined pragmatically aiming at the most rapid pressurization tolerated while avoiding excessive face leaks and patient discomfort. According to Prinianakis et al, such ramps settings (maximum 350 ms in 1 of 13 patients) have a limited effect on T i and intrinsic PEEP [26]. Fourth, despite having set the NAVA level according to the manufacturer's procedure and because of very different airway pressure profiles during PS and NAVA [13], the comparability of assistance levels in PS and NAVA is questionable.…”

Section: Discussionmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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“…15 In the clinical setting, low respiratory drive, respiratory frequency, and absence of hyperinflation are associated with auto-triggering. [16][17][18] In this study, all the ventilators except for the G5 showed acceptable cycling off capability (approximately Ϯ 50 ms), even in the presence of system leak in the COPD model. However, Ferreira et al reported that the Servo-i and the BiPAP Vision showed cycling delay times of approximately 200 ms and 800 ms respectively under similar lung mechanics and leak conditions.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study

et al. 2013

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Effect of varying the pressurisation rate during noninvasive pressure support ventilation

Cited by 60 publications

References 33 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

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study

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