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Respiratory muscle workload in intubated, spontaneously breathing patients without COPD: pressure support vs proportional assist ventilation.

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Delaere, Stéphanie [UCL] Roeseler, Jean [UCL] D'Hoore, William [UCL] Matte, Pascal [UCL] Reynaert, Marc [UCL] Liistro, Giuseppe [UCL]

OBJECTIVE: To compare the respiratory muscle workload associated with pressure support ventilation (PSV) and proportional assist ventilation (PAV) in intubated and spontaneously breathing patients without COPD. DESIGN AND SETTING: Prospective study, intensive care unit university hospital. INTERVENTIONS: Twenty intubated patients, during early weaning, PSV settings made by clinician in charge of the patient, and two levels of PAV, set to counterbalance 80% (PAV 80) and 50% (PAV 50) of both elastic and resistive loads, respectively. The patients were ventilated in the following order: 1) PSV; 2) PAV 50 or PAV 80; 3) PSV; 4) PAV 80 or PAV 50; 5) PSV. PSV settings were kept constant. MEASUREMENTS: Arterial blood gases, breathing pattern and respiratory effort parameters at the end of each of the five steps. MAIN RESULTS: PSV and PAV 80 had the same effects on work of breathing (WOB). The pressure-time product (PTP) was significantly higher during PAV 80 than during PSV (90+/-76 and 61+/-56 cmH(2)O.s.min(-1), respectively, P <0.05). Tidal volume was comparable, albeit more variable with PAV 80 than with PSV (variation coefficient, 43% vs 25%, respectively, P <0.05). PAV 50 entailed a higher respiratory rate, lower tidal volume, and higher WOB and PTP than PSV and PAV 80. PaO(2)/FiO(2) and SaO(2) were lower with PAV 50 than with PSV and PAV 80. CONCLUSION: In a group of intubated spontaneously breathing non-COPD patients, PAV 80 and PSV were associated with comparable levels WOB, whereas PTP was higher during PAV 80. PAV 50 provided insufficient respiratory assistance.

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Référence bibliographique Delaere, Stéphanie ; Roeseler, Jean ; D'Hoore, William ; Matte, Pascal ; Reynaert, Marc ; et. al. Respiratory muscle workload in intubated, spontaneously breathing patients without COPD: pressure support vs proportional assist ventilation.. In: Intensive care medicine, Vol. 29, no. 6, p. 949-54 (2003)
Permalien http://hdl.handle.net/2078.1/9417