OBJECTIVE: To compare the effects of pressure support ventilation (PSV) delivered at the same level by three different ventilators on patients' work of breathing (WOB), breathing pattern and gas exchange. DESIGN: Prospective, self-controlled clinical study. SETTING:Intensive care unit of a tertiary university hospital. PATIENTS: Nine intubated adult patients during weaning from mechanical ventilation. INTERVENTIONS: Patients were randomly connected to one of three ventilators: the Siemens Servo 900 C (SC), the Ohmeda CPU 1 (CPU), and the Engström Erica (EE) during both zero cmH2O PSV and 15 cmH2O PSV. MEASUREMENTS AND RESULTS: During zero PSV, there was no significant difference in terms of WOB, VT, VE, or auto-PEEP among the three ventilators, although there was a trend towards higher levels of WOB with EE. During 15 cmH2O PSV, WOB was significantly less with SC than with EE or CPU (0.47 +/- 0.48 J/l for SC, 1.0 +/- 0.48 for EE and 0.78 +/- 0.51 for CPU1, p = 0.003). WOB was 64% less than at zero PSV with SC but only 38% less with EE. This was associated with a different pressurization shape, as assessed by the interior surface of Paw-VT loops (1.23 +/- 0.09 J/l for SC, 0.9 +/- 0.02 for EE, and 0.79 +/- 0.18 for CPU; p < 0.001). At 15 cmH2O PSV, auto-PEEP was significantly lower with SC than with EE (1.7 +/- 2.1 cmH2O for SC, 4.7 +/- 3.6 for EE, and 2.8 +/- 0.3 for CPU; p = 0.04). External expiratory resistances, in cmH2O/l/s, were significantly higher with EE than with CPU or SC (12.9 +/- 3.2 EE, 7.5 +/- 2.4 CPU, 5.9 +/- 0.5 SC; p < 0.001). CONCLUSION: During PSV, the different working principles of different mechanical ventilators profoundly affect patient's WOB. Among the various factors, velocity of pressurization of PSV may play a role in its efficacy in unloading the respiratory muscles.
RCT Entities:
OBJECTIVE: To compare the effects of pressure support ventilation (PSV) delivered at the same level by three different ventilators on patients' work of breathing (WOB), breathing pattern and gas exchange. DESIGN: Prospective, self-controlled clinical study. SETTING: Intensive care unit of a tertiary university hospital. PATIENTS: Nine intubated adult patients during weaning from mechanical ventilation. INTERVENTIONS:Patients were randomly connected to one of three ventilators: the Siemens Servo 900 C (SC), the Ohmeda CPU 1 (CPU), and the Engström Erica (EE) during both zero cmH2O PSV and 15 cmH2O PSV. MEASUREMENTS AND RESULTS: During zero PSV, there was no significant difference in terms of WOB, VT, VE, or auto-PEEP among the three ventilators, although there was a trend towards higher levels of WOB with EE. During 15 cmH2O PSV, WOB was significantly less with SC than with EE or CPU (0.47 +/- 0.48 J/l for SC, 1.0 +/- 0.48 for EE and 0.78 +/- 0.51 for CPU1, p = 0.003). WOB was 64% less than at zero PSV with SC but only 38% less with EE. This was associated with a different pressurization shape, as assessed by the interior surface of Paw-VT loops (1.23 +/- 0.09 J/l for SC, 0.9 +/- 0.02 for EE, and 0.79 +/- 0.18 for CPU; p < 0.001). At 15 cmH2O PSV, auto-PEEP was significantly lower with SC than with EE (1.7 +/- 2.1 cmH2O for SC, 4.7 +/- 3.6 for EE, and 2.8 +/- 0.3 for CPU; p = 0.04). External expiratory resistances, in cmH2O/l/s, were significantly higher with EE than with CPU or SC (12.9 +/- 3.2 EE, 7.5 +/- 2.4 CPU, 5.9 +/- 0.5 SC; p < 0.001). CONCLUSION: During PSV, the different working principles of different mechanical ventilators profoundly affect patient's WOB. Among the various factors, velocity of pressurization of PSV may play a role in its efficacy in unloading the respiratory muscles.
Authors: A Esteban; F Frutos; M J Tobin; I Alía; J F Solsona; I Valverdú; R Fernández; M A de la Cal; S Benito; R Tomás Journal: N Engl J Med Date: 1995-02-09 Impact factor: 91.245
Authors: Jan Buytaert; Paula Collins; Adam Abed Abud; Phil Allport; Antonio Pazos Álvarez; Kazuyoshi Akiba; Oscar Augusto de Aguiar Francisco; Aurelio Bay; Florian Bernard; Sophie Baron; Claudia Bertella; Josef X Brunner; Themis Bowcock; Martine Buytaert-De Jode; Wiktor Byczynski; Ricardo De Carvalho; Victor Coco; Ruth Collins; Nikola Dikic; Nicolas Dousse; Bruce Dowd; Kārlis Dreimanis; Raphael Dumps; Paolo Durante; Walid Fadel; Stephen Farry; Antonio Fernàndez Prieto; Arturo Fernàndez Tèllez; Gordon Flynn; Vinicius Franco Lima; Raymond Frei; Abraham Gallas Torreira; Tonatiuh García Chàvez; Evangelos Gazis; Roberto Guida; Karol Hennessy; Andre Henriques; David Hutchcroft; Stefan Ilic; Artūrs Ivanovs; Aleksandar Jevtic; Emigdio Jimenez Dominguez; Christian Joram; Kacper Kapusniak; Edgar Lemos Cid; Jana Lindner; Rolf Lindner; M Ivàn Martínez Hernàndez; Mirko Meboldt; Marko Milovanovic; Sylvain Mico; Johan Morant; Michel Morel; Georg Männel; Dónal Murray; Irina Nasteva; Niko Neufeld; Igor Neuhold; Francisco Pardo-Sobrino López; Eliseo Pèrez Trigo; Gonzalo Pichel Jallas; Edyta Pilorz; Lise Piquilloud; Xavier Pons; David Reiner; Hector David Règules Medel; Saul Rodríguez Ramírez; Mario Rodíguez Cahuantzi; Carl Roosens; Philipp Rostalski; Freek Sanders; Eric Saucet; Marianne Schmid Daners; Burkhard Schmidt; Patrick Schoettker; Rainer Schwemmer; Heinrich Schindler; Archana Sharma; Derick Sivakumaran; Christophe Sigaud; Vasilios Spitas; Nicola Steffen; Peter Svihra; Guillermo Tejeda Muñoz; Nikolaos Tachatos; Efstratios Tsolakis; Jan van Leemput; Laurence Vignaux; Francois Vasey; Hamish Woonton; Ken Wyllie Journal: R Soc Open Sci Date: 2022-03-16 Impact factor: 2.963