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Intensive Care Medicine

Published in:

01-08-2008 | Original

Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation

Authors: Arnaud W. Thille, Belen Cabello, Fabrice Galia, Aissam Lyazidi, Laurent Brochard

Published in: Intensive Care Medicine | Issue 8/2008

Abstract

Objective

To identify ventilatory setting adjustments that improve patient-ventilator synchrony during pressure-support ventilation in ventilator-dependent patients by reducing ineffective triggering events without decreasing tolerance.

Design and setting

Prospective physiological study in a 13-bed medical intensive care unit in a university hospital.

Patients and participants

Twelve intubated patients with more than 10% of ineffective breaths while receiving pressure-support ventilation.

Interventions

Flow, airway-pressure, esophageal-pressure, and gastric-pressure signals were used to measure patient inspiratory effort. To decrease ineffective triggering the following ventilator setting adjustments were randomly adjusted: pressure support reduction, insufflation time reduction, and change in end-expiratory pressure.

Measurements and results

Reducing pressure support from 20.0 cm H₂O (IQR 19.5–20) to 13.0 (12.0–14.0) reduced tidal volume [10.2 ml/kg predicted body weight (7.2–11.5) to 5.9 (4.9–6.7)] and minimized ineffective triggering events [45% of respiratory efforts (36–52) to 0% (0–7)], completely abolishing ineffective triggering in two-thirds of patients. The ventilator respiratory rate increased due to unmasked wasted efforts, with no changes in patient respiratory rate [26.5 breaths/min (23.1–31.9) vs. 29.4 (24.6–34.5)], patient effort, or arterial PCO₂. Shortening the insufflation time reduced ineffective triggering events and patient effort, while applying positive end-expiratory pressure had no influence on asynchrony.

Conclusions

Markedly reducing pressure support or inspiratory duration to reach a tidal volume of about 6 ml/kg predicted body weight eliminated ineffective triggering in two-thirds of patients with weaning difficulties and a high percentage of ineffective efforts without inducing excessive work of breathing or modifying patient respiratory rate.

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Title: Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation
Authors: Arnaud W. Thille
Belen Cabello
Fabrice Galia
Aissam Lyazidi
Laurent Brochard
Publication date: 01-08-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1121-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation

Abstract

Objective

Design and setting

Patients and participants

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients and participants

Interventions

Measurements and results

Conclusions

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