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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2002, Number 1

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An Med Asoc Med Hosp ABC 2002; 47 (1)

Pressure support as a mechanical ventilation modality: A study of metabolic effects

Guadarrama QF, Cruz VJA, Rubio MR, García MT, Elizalde GJJ, Luna OP

Language: Spanish
References: 21
Page: 19-23
PDF size: 43.14 Kb.


ABSTRACT

Objective: To analyze metabolic changes in critically ill patients upon change in mode of mechanical ventilation from Assist-Control Ventilation (ACV) to Pressure Support Ventilation (PSV), out of the weaning context. Design: Controlled, prospective, clinical trial. Setting: Multidisciplinary intensive care unit of a private tertiary center. Patients: Critically ill patients who meet the following: Entry criteria: 1) ventilator support, 2) maximal inspiratory pressure (MIP) > –25 mm Hg and 3) rapid shallow breathing index (RSB) <100 b/min/L. Exclusion criteria: 1) Sepsis, 2) fever, 3) chest tubes, 4) neurological impairment and 5) hemodynamic instability, and/or respiratory instability. Interventions: Change in ventilator support mode from assist-controlled ventilation to pressure support ventilation. Measurements: Oxygen consumption, CO2 production and energy expenditure; also tidal volume and minute volume. Results: Upon changing to PSV patients showed a minor increase in minute volume and O2 consumption and a minor decrease in CO2 production and energy expenditure. Conclusion: Change of ventilatory mode from assist-controlled to PSV is not a cause of important metabolic changes.


REFERENCES

  1. Dekel B, Segal E, Perel A. Pressure support ventilation. Arch Intern Med 1996; 156: 367-373.

  2. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991; 324: 1444-1450.

  3. MacIntyre NR. Respiratory function during pressure support ventilation. Chest 1986; 89: 677-683.

  4. Brochard L, Harf A, Lorino H, Lemaire F. Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 1989; 139: 513-521.

  5. Hormann C, Baum M, Luz G, Putensen C, Putz G. Tidal volume, breathing frequency, and oxygen consumption at different pressure support levels in the early stage of weaning in patients without chronic obstructive pulmonary disease. Intensive Care Med 1992; 18 (4): 226-230.

  6. Prakash O, Meij S. Cardiopulmonary response to inspiratory pressure support during spontaneous ventilation vs conventional ventilation. Chest 1985; 88: 403-408.

  7. Van de Graff WB et al. Pressure support: Changes in ventilatory pattern and components of the work of breathing. Chest 1991; 100: 1082-1011.

  8. Makita K, Nunn J, Royston B. Evaluation of metabolic measuring instruments for use in critically ill patients. Critical Care Med 1990; 18: 638-644.

  9. Chittock DR, Ronco JJ, Russell J. Respiratory monitoring. In: Tobin MJ. Principles and practice of intensive care monitoring. USA: McGraw Hill, 1988; 317.

  10. Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101: 1644-1655.

  11. Hess DR. Capnometry. In: Tobin MJ. Principles and practice of intensive care monitoring. USA: McGraw Hill. 1988; 377.

  12. Hubmayr RD, Loosbrack LM et al. Oxygen uptake during weaning from mechanical ventilation. Chest 1988; 94: 1148-1155.

  13. Lemaire F, Teboul JL et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1989; 69: 171-179.

  14. Shapiro M, Wilson RK et al. Work of breathing through different sized endotracheal tubes. Crit Care Med 1986; 14: 1028-1031.

  15. Fiastro JF, Habib MP, Quan SF. Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 1988; 93: 499-505.

  16. Kirkland L, Effects of ventilator resetting on indirect calorimetry measurement-The importance of patience. Crit Care Med 1999; 27(3): 459-460.

  17. Gandia F, Blanco J. Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load. Intensive Care Med 1992; 18 (6):3327-333.

  18. Brochard L. Rua F et al. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 1991; 75: 739-745.

  19. Brochard L, Pluskwa F et al. Improved Efficacy of inspiratory pressure support. Am Rev Respir Dis 1987; 136: 411-415.

  20. Brandi LS, Bertolini R, Santini L, Cavani S. Effects of ventilator resetting on indirect calorimetry measurement in the critically ill surgical patient. Crit Care Med 1999; 27 (3): 531-539.

  21. Swinamer DL, Fedoruk LM, Jones RL, Chin WD, Phang PT, Hamilton SM, King EG. Energy expenditure associated with CPAP and T-piece spontaneous ventilatory trials. Changes following prolonged mechanical ventilation. Chest 1989; 96 (4): 867-728.




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