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- Title
A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV).
- Authors
Costa, R.; Spinazzola, G.; Cipriani, F.; Ferrone, G.; Festa, O.; Arcangeli, A.; Antonelli, M.; Proietti, R.; Conti, G.
- Abstract
Purpose: To compare patient-ventilator interaction during PSV and PAV+ in patients that are difficult to wean. Methods: This was a physiologic study involving 11 patients. During three consecutive trials (PSV first trial-PSV1, followed by PAV+, followed by a second PSV trial-PSV2, with the same settings as PSV1) we evaluated mechanical and patient respiratory pattern; inspiratory effort from excursion Pdi (swing), and pressure-time products of the transdiaphragmatic (PTPdi) pressures. Inspiratory (delay) and expiratory (delay) trigger delays, time of synchrony (time), and asynchrony index (AI) were assessed. Results: Compared to PAV+, during PSV trials, the mechanical inspiratory time (Ti) was significantly longer than patient inspiratory time (Ti) ( p < 0.05); Ti showed a prolongation between PSV1 and PAV+, significant comparing PAV+ and PSV2 ( p < 0.05). PAV+ significantly reduced delay ( p < 0.001). The portion of tidal volume (VT) delivered in phase with Ti (VT/VT) was significantly higher during PAV+ ( p < 0.01). The time of synchrony was significantly longer during PAV+ than during PSV ( p < 0.001). During PSV 5 patients out of 11 showed an AI greater than 10%, whereas the AI was nil during PAV+. Conclusion: PAV+ improves patient-ventilator interaction, significantly reducing the incidence of end-expiratory asynchrony and increasing the time of synchrony.
- Subjects
VENTILATION; MECHANICAL ventilators; ADULT respiratory distress syndrome; MEDICAL care; RESPIRATION; PATIENTS
- Publication
Intensive Care Medicine, 2011, Vol 37, Issue 9, p1494
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-011-2297-y