Top

Intensive Care Medicine

Published in:

01-09-2011 | Original

A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)

Authors: R. Costa, G. Spinazzola, F. Cipriani, G. Ferrone, O. Festa, A. Arcangeli, M. Antonelli, R. Proietti, G. Conti

Published in: Intensive Care Medicine | Issue 9/2011

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_Pdi), and pressure–time products of the transdiaphragmatic (PTPdi) pressures. Inspiratory (delay_trinsp) and expiratory (delay_trexp) trigger delays, time of synchrony (time_syn), and asynchrony index (AI) were assessed.

Results

Compared to PAV+, during PSV trials, the mechanical inspiratory time (Ti_flow) was significantly longer than patient inspiratory time (Ti_pat) (p < 0.05); Ti_pat showed a prolongation between PSV1 and PAV+, significant comparing PAV+ and PSV2 (p < 0.05). PAV+ significantly reduced delay_trexp (p < 0.001). The portion of tidal volume (VT) delivered in phase with Ti_pat (VT_pat/VT_mecc) 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.

Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344:1986–1996PubMedCrossRef

Kilburn KH (1966) Shock, seizures and coma with alkalosis during mechanical ventilation. Ann Intern Med 65:977–984PubMed

Ayres SM, Grace WJ (1969) Inappropriate ventilation and hypoxemia as causes of cardiac arrhythmias. The control of arrhythmias without antiarrhythmic drugs. Am J Med 46:495–505PubMedCrossRef

Argov Z, Mastaglia FL (1979) Disorders of neuromuscular transmission caused by drugs. New Engl J Med 301:409–413PubMedCrossRef

Le Bourdelles G, Viires N, Boczkowski J et al (1994) Effects of mechanical ventilation on diaphragmatic contractile properties in rats. Am J Respir Crit Care Med 149:1539–1544PubMed

Yamada Y, Du HL (2000) Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach. J Appl Physiol 88:2134–2150

Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424PubMed

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient–ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRef

Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112:1592–1599PubMedCrossRef

10.

Younes M (1994) Proportional assist ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 349–369

11.

Ranieri M, Giuliani R, Mascia L, Grasso S, Petruzzelli V, Puntillo N, Perchiazzi G, Fiore T, Brienza A (1996) Patient–ventilator interaction during acute hypercapnia: pressure support vs proportional assist ventilation. J Appl Physiol 81:426–436PubMed

12.

Grasso S, Puntillo F, Mascia L, Ancona G, Fiore T, Bruno F, Slutsky AS, Ranieri VM (2000) Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation. Am J Respir Crit Care Med 161:819–826PubMed

13.

Giannouli E, Webster K, Roberts D, Younes M (1999) Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med 159:1716–1725PubMed

14.

Navalesi P, Hernandez P, Wongsa A, La Porta D, Goldberg B, Gottfried S (1996) Proportional assist ventilation in acute respiratory failure; effects on breathing pattern and inspiratory effort. Am J Respir Crit Care Med 154:1330–1338PubMed

15.

Du HL, Ohtsuji M, Shigeta M, Chao DC, Sasaki K, Usuda Y, Yamada Y (2002) Expiratory asynchrony in proportional assist ventilation. Am J Respir Crit Care Med 165:972–977PubMed

16.

Younes M, Kun J, Masiowski B, Webster K, Roberts D (2001) A method for noninvasive determination of inspiratory resistance during proportional assist ventilation. Am J Respir Crit Care Med 163:829–839PubMed

17.

Younes M, Webster K, Kun J, Roberts D, Masiowski B (2001) A method for measuring passive elastance during proportional assist ventilation. Am J Respir Crit Care Med 164:50–60PubMed

18.

Kondili E, Prinianakis G, Alexopoulou C, Vakouti E, Klimathianaki M, Georgopoulos D (2006) Respiratory load compensation during mechanical ventilation—proportional assist ventilation with load-adjustable gain factors versus pressure support. Intensive Care Med 32:692–699PubMedCrossRef

19.

Xirouchaki N, Kondili E, Vaporidi K, Xirouchakis G, Klimathianaki M, Gavriilidis G, Alexandopoulou E, Plataki M, Alexopoulou C, Georgopoulos D (2008) Proportional assist ventilation with load-adjustable gain factors in critically ill patients: comparison with pressure support. Intensive Care Med 34:2026–2031PubMedCrossRef

20.

Chiumello D, Pelosi P, Taccone P, Slutsky A, Gattinoni L (2003) Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. Crit Care Med 31(11):2604–2610PubMedCrossRef

21.

Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed

22.

Navalesi P, Costa R, Ceriana P, Carlucci A, Prinianakis G, Antonelli M, Conti G, Nava S (2007) Non invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med 33:74–81

23.

Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Della Corte FD, Navalesi P (2010) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med

Title: A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)
Authors: R. Costa
G. Spinazzola
F. Cipriani
G. Ferrone
O. Festa
A. Arcangeli
M. Antonelli
R. Proietti
G. Conti
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2297-y

At a glance: The STEP trials

Springer Medicine

A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2011

Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control

Predicting prolonged intensive care unit stays in older cardiac surgery patients: a validation study

Early steroid therapy for patients with H1N1 influenza A virus infection

Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

End-inspiratory rebreathing reduces the end-tidal to arterial PCO2 gradient in mechanically ventilated pigs

The role of renal hypoperfusion in development of renal microcirculatory dysfunction in endotoxemic rats