Abstract
Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV.Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS10), 30% (PS30), 50% (PS50), and automatic adjustment PSV (PSAUTO). Patient-ventilator interactions were measured.Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PSAUTO when compared with PS10, PS30, and PS50, (P < 0.05). The benefit of PSAUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PSAUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PSAUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes.Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.
Highlights
Pressure support ventilation (PSV) is the most widely used partial mode of assistance to minimize the effort of patients in breathing
Total AI and micro-AI were lower in PSAUTO when compared with PS10 and PS30 in the obstructive subgroup and were lower in PSAUTO when compared with PS50 in the restrictive subgroup (Supplementary Table 2)
This study showed that when compared with PSV with prefixed pneumatic controllers, an automatic adjustment system decreased total AI and improved patient-ventilator interaction mainly through a decrease of micro-asynchronies
Summary
Pressure support ventilation (PSV) is the most widely used partial mode of assistance to minimize the effort of patients in breathing. During PSV, prefixed pneumatic controllers can become progressively less effective, especially when patients have abnormal respiratory mechanics or ventilator over-assist [7]. With prefixed cyclingoff criteria, such as the default value of 30% peak flow in some ventilators, premature cycling is more frequent in patients with restrictive breathing patterns characterized by low respiratory system compliance and may result in double triggering. Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients.
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