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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2007

01-01-2007 | Pediatric Original

Positive end-expiratory pressure and pressure support in peripheral airways obstruction

Work of breathing in intubated children

Authors: Alan S. Graham, Girish Chandrashekharaiah, Agop Citak, Randall C. Wetzel, Christopher J. L. Newth

Published in: Intensive Care Medicine | Issue 1/2007

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Abstract

Objectives

Children with peripheral airways obstruction suffer the negative effects of intrinsic positive end-expiratory pressure: increased work of breathing and difficulty triggering assisted ventilatory support. We examined whether external positive end-expiratory pressure to offset intrinsic positive end-expiratory pressure decreases work of breathing in children with peripheral airways obstruction. The change in work of breathing with incremental pressure support was also tested.

Design and setting

Prospective clinical trial in a pediatric intensive care unit.

Patients

Eleven mechanically ventilated, spontaneously breathing children with peripheral airways obstruction.

Interventions

Work of breathing (using pressure-rate product as a surrogate) was measured in three tiers: (a) Increasing pressure support over zero end-expiratory pressure. (b) Increasing applied positive end-expiratory pressure and fixed pressure support. The level of applied positive end-expiratory pressure at which pressure-rate product was least determined the compensatory positive end-expiratory pressure. (c) Increasing pressure support over compensatory (fixed) positive end-expiratory pressure.

Measurements and results

Increases in pressure support alone decreased pressure-rate product from mean 724 ± 311 to 403 ± 192 cmH2O/min. Applied positive end-expiratory pressure alone decreased pressure-rate product from mean 608 ± 301 to 250 ± 169 cmH2O/min. The lowest pressure-rate product (136 ± 128 cmH2O/min) was achieved using compensatory positive end-expiratory pressure (12 ± 4 cmH2O) with pressure support 16 cmH2O.

Conclusions

For children with peripheral airways obstruction who require assisted ventilation, work of breathing during spontaneous breaths is decreased by the application of either compensatory positive end-expiratory pressure or pressure support.
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Metadata
Title
Positive end-expiratory pressure and pressure support in peripheral airways obstruction
Work of breathing in intubated children
Authors
Alan S. Graham
Girish Chandrashekharaiah
Agop Citak
Randall C. Wetzel
Christopher J. L. Newth
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0445-6

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