Inspiratory Pressure Support Compensates for the Additional Work of Breathing Caused by the Endotracheal Tube

Brochard, Laurent; Rua, Fernando; Lorino, H.; Lemaire, F; Harf, Alain

doi:10.1097/00000542-199111000-00004

Cited by 301 publications

(149 citation statements)

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“…Pressure support levels were set between 5 and 10 cmH 2 O in studies of weaning with PSV; such levels were suggested to be effective in overcoming the resistance and workload of endotracheal tube and respiratory circuits [26,[34][35][36][37]. SULZER et al [9] decreased minute volume to 25% of the baseline value in cardiac surgery patients and achieved extubation with this level of support.…”

Section: Weaning Protocols and Settingsmentioning

confidence: 99%

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Kıraklı

Özdemir

Uçar

et al. 2011

European Respiratory Journal

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Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV.From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode.Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p50.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant.This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

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Section: Weaning Protocols and Settingsmentioning

confidence: 99%

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Kıraklı

Özdemir

Uçar

et al. 2011

European Respiratory Journal

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“…22 Several studies found no differences in work of breathing 23,24 or in P 0.1 measurements 24 during low levels of pressure support compared with T-piece breathing. In our study, if the level of pressure support applied had been low enough to entail an increase in P 0.1 due to the additional work of breathing caused by the endotracheal tube and the circuit, it could have counterbalanced an eventual decrease in P 0.1 .…”

Section: Discussionmentioning

confidence: 97%

Role of Respiratory Drive in Hyperoxia-Induced Hypercapnia in Ready-to-Wean Subjects With COPD

et al. 2014

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BACKGROUND: Hyperoxia-induced hypercapnia in subjects with COPD is mainly explained by alterations in the ventilation/perfusion ratio. However, it is unclear why respiratory drive does not prevent CO 2 retention. Some authors have highlighted the importance of respiratory drive in CO 2 increases during hyperoxia. The aim of the study was to examine the effects of hyperoxia on respiratory drive in subjects with COPD. METHODS: Fourteen intubated, ready-to-wean subjects with COPD were studied during normoxia and hyperoxia. A CO 2 response test was then performed with the rebreathing method to measure the hypercapnic drive response, defined as the ratio of change in airway-occlusion pressure 0.1 s after the start of inspiratory flow (⌬P 0.1 ) to change in P aCO 2 (⌬P aCO 2 ), and the hypercapnic ventilatory response, defined as the ratio of change in minute volume (⌬V E ) to ⌬P aCO 2 . RESULTS: Hyperoxia produced a significant increase in P aCO 2 (55 ؎ 9 vs 58 ؎ 10 mm Hg, P ‫؍‬ .02) and a decrease in pH (7.41 ؎ 0.05 vs 7.38 ؎ 0.05, P ‫؍‬ .01) compared with normoxia, with a non-significant decrease in V E (9.9 ؎ 2.9 vs 9.1 ؎ 2.3 L/min, P ‫؍‬ .16) and no changes in In ready-to-wean subjects with COPD exacerbations, hyperoxia is followed by an increase in P aCO 2 , but it does not significantly modify the respiratory drive or the ventilatory response to hypercapnia.

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“…Another interesting effect of PSV is that it is useful to overcome the extra work of breathing imposed by the endotracheal tube and the inspiratory valve and circuit of the ventilator [39,40]. The level of pressure support necessary to eliminate this extra work, which is induced by a flow-dependent pressure drop across the endotracheal tube, depends on various factors: the diameter of the endotracheal tube; the patients' inspiratory drive; and the presence or absence of a severe underlying lung disease.…”

Section: Pressure Support Ventilationmentioning

confidence: 99%

Weaning from mechanical ventilation

Mancebo

1996

Eur Respir J

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W We ea an ni in ng g f fr ro om m m me ec ch ha an ni ic ca al l v ve en nt ti il la at ti io on n J. ManceboWeaning from mechanical ventilation. J. Mancebo. ERS Journals Ltd 1996. ABSTRACT: Weaning from mechanical ventilation is a period of transition from total ventilatory support to spontaneous breathing. It represents a relevant clinical problem because as many as 25% of intubated and mechanically-ventilated critically ill patients will need a progressive withdrawal from artificial ventilatory support.From a clinical standpoint, it is very important to recognize as soon as possible when a patient is ready to be weaned. Accordingly, a daily routine follow-up should be performed in every patient in order to verify whether patients meet clinical criteria to be disconnected from the ventilator. Several physiological indices have been used to predict the outcome of weaning trials. However, an adequate clinical tolerance to spontaneous breathing during a 2 h T-piece trial is very useful to predict a successful extubation.A number of physiopathological mechanisms explain why some patients fail the weaning trials; particularly important from a clinical point of view are those related to respiratory pump failure and cardiovascular instability, which are usually accompanied by an abnormal gas exchange.Different ventilatory techniques can be used to wean these patients from mechanical ventilation. Up to now, the most efficient techniques seem to be pressure support ventilation and once daily trials of T-piece interspersed with conventional volume assist-control ventilation.Finally, knowledge-based system applied to modern microprocessor mechanical ventilators can help in the process of weaning by automatically reducing the ventilatory assistance and indicating the optimal time to perform extubation.

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Inspiratory Pressure Support Compensates for the Additional Work of Breathing Caused by the Endotracheal Tube

Cited by 301 publications

References 0 publications

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Role of Respiratory Drive in Hyperoxia-Induced Hypercapnia in Ready-to-Wean Subjects With COPD

Weaning from mechanical ventilation

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