OBJECTIVES: During proportional assist ventilation with load-adjustable gain factors, peak respiratory muscle pressure can be estimated from the peak airway pressure and the percentage of assistance (gain). Adjusting the gain can, therefore, target a given level of respiratory effort. This study assessed the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors with the goal of targeting a predefined range of respiratory effort. DESIGN: Prospective, multicenter, clinical observational study. SETTINGS: Intensive care departments at five university hospitals. PATIENTS: Patients were included after meeting simple criteria for assisted mechanical ventilation. INTERVENTIONS: Patients were ventilated in proportional assist ventilation with load-adjustable gain factors. The peak respiratory muscle pressure, estimated in cm H2O as (peak airway pressure-positive end-expiratory pressure)×[(100-gain)/gain], was calculated from a grid at the bedside. The gain adjustment algorithm was defined to target a peak respiratory muscle pressure between 5 and 10 cm H2O. Additional recommendations were available in case of hypoventilation or hyperventilation. RESULTS: Fifty-three patients were enrolled. Median time spent under proportional assist ventilation with load-adjustable gain factors was 3 days (interquartile range, 1-5). Gain was adjusted 1.0 (0.7-1.8) times per day, according to the peak respiratory muscle pressure target range in 91% of cases and because of hypoventilation or hyperventilation in 9%. Thirty-four patients were ventilated with proportional assist ventilation with load-adjustable gain factors until extubation, which was successful in 32. Eighteen patients required volume assist-controlled reventilation because of clinical worsening and need for continuous sedation. One patient was intolerant to proportional assist ventilation with load-adjustable gain factors. CONCLUSIONS: This first study assessing the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors in an attempt to target a predefined range of effort showed that adjusting the level of assistance to maintain a predefined boundary of respiratory muscle pressure is feasible, simple, and often sufficient to ventilate patients until extubation.
OBJECTIVES: During proportional assist ventilation with load-adjustable gain factors, peak respiratory muscle pressure can be estimated from the peak airway pressure and the percentage of assistance (gain). Adjusting the gain can, therefore, target a given level of respiratory effort. This study assessed the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors with the goal of targeting a predefined range of respiratory effort. DESIGN: Prospective, multicenter, clinical observational study. SETTINGS: Intensive care departments at five university hospitals. PATIENTS: Patients were included after meeting simple criteria for assisted mechanical ventilation. INTERVENTIONS:Patients were ventilated in proportional assist ventilation with load-adjustable gain factors. The peak respiratory muscle pressure, estimated in cm H2O as (peak airway pressure-positive end-expiratory pressure)×[(100-gain)/gain], was calculated from a grid at the bedside. The gain adjustment algorithm was defined to target a peak respiratory muscle pressure between 5 and 10 cm H2O. Additional recommendations were available in case of hypoventilation or hyperventilation. RESULTS: Fifty-three patients were enrolled. Median time spent under proportional assist ventilation with load-adjustable gain factors was 3 days (interquartile range, 1-5). Gain was adjusted 1.0 (0.7-1.8) times per day, according to the peak respiratory muscle pressure target range in 91% of cases and because of hypoventilation or hyperventilation in 9%. Thirty-four patients were ventilated with proportional assist ventilation with load-adjustable gain factors until extubation, which was successful in 32. Eighteen patients required volume assist-controlled reventilation because of clinical worsening and need for continuous sedation. One patient was intolerant to proportional assist ventilation with load-adjustable gain factors. CONCLUSIONS: This first study assessing the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors in an attempt to target a predefined range of effort showed that adjusting the level of assistance to maintain a predefined boundary of respiratory muscle pressure is feasible, simple, and often sufficient to ventilate patients until extubation.
Authors: Elena Spinelli; Tommaso Mauri; Jeremy R Beitler; Antonio Pesenti; Daniel Brodie Journal: Intensive Care Med Date: 2020-02-03 Impact factor: 17.440
Authors: Michele Bertoni; Irene Telias; Martin Urner; Michael Long; Lorenzo Del Sorbo; Eddy Fan; Christer Sinderby; Jennifer Beck; Ling Liu; Haibo Qiu; Jenna Wong; Arthur S Slutsky; Niall D Ferguson; Laurent J Brochard; Ewan C Goligher Journal: Crit Care Date: 2019-11-06 Impact factor: 9.097
Authors: Ewan C Goligher; Martin Dres; Bhakti K Patel; Sarina K Sahetya; Jeremy R Beitler; Irene Telias; Takeshi Yoshida; Katerina Vaporidi; Domenico Luca Grieco; Tom Schepens; Giacomo Grasselli; Savino Spadaro; Jose Dianti; Marcelo Amato; Giacomo Bellani; Alexandre Demoule; Eddy Fan; Niall D Ferguson; Dimitrios Georgopoulos; Claude Guérin; Robinder G Khemani; Franco Laghi; Alain Mercat; Francesco Mojoli; Coen A C Ottenheijm; Samir Jaber; Leo Heunks; Jordi Mancebo; Tommaso Mauri; Antonio Pesenti; Laurent Brochard Journal: Am J Respir Crit Care Med Date: 2020-10-01 Impact factor: 30.528