Patient-ventilator interaction during acute hypercapnia: Pressure-support vs proportional-assist ventilation

被引:99
作者
Ranieri, VM
Giuliani, R
Mascia, L
Grasso, S
Petruzzelli, V
Puntillo, N
Perchiazzi, G
Fiore, T
Brienza, A
机构
[1] Ist. di Anestesiologia e Rianim., Ospedale Policlinico, Università di Bari
[2] Ist. di Anestesiologia e Rianim., Policlinico, 70 124 Bari, Piazza G. Cesare
关键词
carbon dioxide stimulation; weaning;
D O I
10.1152/jappl.1996.81.1.426
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
The objective of this study was to compare patient-ventilator interaction during pressure-support ventilation (PSV) and proportional-assist ventilation (PAV) in tile course of increased ventilatory requirement obtained by adding a dead space in 12 patients on weaning from mechanical ventilation. With PSV. the level of unloading was provided by setting the inspiratory pressure at 20 and 10 cmH(2)O, whereas with PAV the level of unloading was at 80 and 40% of the elastic and resistive load. Hypercapnia increased (P < 0.001) tidal swing of esophageal pressure and pressure-time product per breath at both levels of PSV and PAV. During PSV, application of dead space increased ventilation (V-E) during PSV (67 +/- 4 and 145 +/- 5% during 20 and 10 cmH(2)O PSV, respectively, P < 0.001). This was due to a relevant increase in respiratory rate (48 +/- 4 and 103 +/- 5%C during 20 and 10 cmH(2)O PSV, respectively, P < 0.001), whereas the increase in tidal volume (VT) played a small role (13 +/- 1 and 21 +/- 2% during 20 and 10 cmH(2)O PSV, respectively P < 0.001). With PAV, the increase in V-E consequent to hypercapnia (27 +/- 3 and 64 +/- 4% during 80 and 40% PAV, respectively, P < 0.001) was related to the increase in VT (32 +/- 1 and 66 +/- 2% during 80 and 40% PAV, respectively, P < 0.001), respiratory rate remaining unchanged. The increase in pressure-time product per minute and per liter consequent to acute hypercapnia and the sense of breathlessness were significantly (P < 0.001) higher during PSV than during PAV Our data show that, after hypercapnic stimulation of tile respiratory drive, tile capability to increase VE through changes in VT modulated by variations in inspiratory muscle effort is preserved only during PAV; the compensatory strategy used to increase VE during PSV requires greater muscle effort and causes more pronounced patient discomfort than during PAV.
引用
收藏
页码:426 / 436
页数:11
相关论文
共 37 条
[21]   PHYSICAL PROPERTIES OF HUMAN LUNGS MEASURED DURING SPONTANEOUS RESPIRATION [J].
MEAD, J ;
WHITTENBERGER, JL .
JOURNAL OF APPLIED PHYSIOLOGY, 1953, 5 (12) :779-796
[22]   ABDOMINAL MUSCLE USE DURING BREATHING IN PATIENTS WITH CHRONIC AIR-FLOW OBSTRUCTION [J].
NINANE, V ;
RYPENS, F ;
YERNAULT, JC ;
DETROYER, A .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 146 (01) :16-21
[23]   EXERTIONAL BREATHLESSNESS IN PATIENTS WITH CHRONIC AIR-FLOW LIMITATION - THE ROLE OF LUNG HYPERINFLATION [J].
ODONNELL, DE ;
WEBB, KA .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1993, 148 (05) :1351-1357
[24]   THE WORK OF BREATHING [J].
OTIS, AB .
PHYSIOLOGICAL REVIEWS, 1954, 34 (03) :449-458
[25]   EFFECT OF INSPIRATORY FLOW-RATE ON RESPIRATORY OUTPUT IN NORMAL SUBJECTS [J].
PUDDY, A ;
YOUNES, M .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 146 (03) :787-789
[26]   PHYSIOLOGICAL-EFFECTS OF POSITIVE END-EXPIRATORY PRESSURE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE DURING ACUTE VENTILATORY FAILURE AND CONTROLLED MECHANICAL VENTILATION [J].
RANIERI, VM ;
GIULIANI, R ;
CINELLA, G ;
PESCE, C ;
BRIENZA, N ;
IPPOLITO, EL ;
POMO, V ;
FIORE, T ;
GOTTFRIED, SB ;
BRIENZA, A .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1993, 147 (01) :5-13
[27]   PRESSURE-TIME PRODUCT DURING CONTINUOUS POSITIVE AIRWAY PRESSURE, PRESSURE SUPPORT VENTILATION, AND T-PIECE DURING WEANING FROM MECHANICAL VENTILATION [J].
SASSOON, CSH ;
LIGHT, RW ;
LODIA, R ;
SIECK, GC ;
MAHUTTE, CK .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1991, 143 (03) :469-475
[28]   RESPIRATORY RESPONSE TO INHALED CO2 DURING POSITIVE INSPIRATORY PRESSURE IN HUMANS [J].
SCHEID, P ;
LOFASO, F ;
ISABEY, D ;
HARF, A .
JOURNAL OF APPLIED PHYSIOLOGY, 1994, 77 (02) :876-882
[29]   MECHANICAL VENTILATION [J].
SLUTSKY, AS .
CHEST, 1993, 104 (06) :1833-1859
[30]   FREQUENCY-DEPENDENT EFFECTS OF HYPERCAPNIA ON RESPIRATORY MECHANICS OF CATS [J].
SLY, PD ;
BATES, JHT ;
KOCHI, T ;
OKUBO, S ;
MILICEMILI, J .
JOURNAL OF APPLIED PHYSIOLOGY, 1987, 62 (02) :444-450