Flow-triggering reduces inspiratory effort during weaning from mechanical ventilation

Abstract

To investigate whether a new flow-triggered (FT) system can reduce the patient's inspiratory effort compared to a traditional pressure-triggered (PT) system during weaning from mechanical ventilation. Prospective study. Intensive care unit of a General Hospital. 10 mechanically ventilated patients, without chronic airway disease, ready to wean. Minute ventilation, breathing pattern, lung mechanics, inspiratory work of breathing (WI) and pressure time product (PTP) of Ppl were obtained in two conditions: 1) unsupported spontaneous breathing through the ventilator circuit (SB); 2) spontaneous breathing with continuous positive airway pressure set at 5 cmH2O (CPAP). Two triggering systems, namely PT and FT, were used in each condition. Though there was no change in breathing pattern, minute ventilation, and lung mechanics, the magnitude of the inspiratory effort decreased significantly with FT compared to PT in both instances. The added resistance (total flow resistance minus pulmonary resistance) decreased by 37% on average when FT replaced PT. PTP decreased, on average, 27% and 15% during SB and CPAP, respectively, with FT compared to PT (p < 0.05). A similar significant decrease was observed in WI. The new FT system, i.e. flow-by system, reduces the unintentional ventilatory workload upon the patients' inspiratory muscles compared to traditional PT system during weaning from mechanical ventilation.