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1 Paediatric Pulmonary Dept and Research Unit INSERM E 213, Armand Trousseau Hospital, Assistance Publique – Hôpitaux de Paris, Paris, 2 Paediatric Intensive Care Unit, Bicêtre Hospital, Assistance Publique – Hôpitaux de Paris, Le Kremlin Bicêtre, and 4 Physiology Dept, Raymond Poincaré Hospital, Assistance Publique – Hôpitaux de Paris, Garches, France. 3 Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK.
CORRESPONDENCE: B. Fauroux, Service de Pneumologie Pédiatrique and Research unit INSERM E 213, Hôpital d'Enfants Armand Trousseau, AP-HP 28, avenue du Docteur Arnold Netter, 75012 Paris, France. Fax: 33 144736718. E-mail: brigitte.fauroux@trs.ap-hop-paris.fr
Keywords: Cystic fibrosis, noninvasive mechanical ventilation, patient-ventilator synchronisation, pressure support ventilation, work of breathing
Received: December 12, 2003
Accepted May 20, 2004
This study was supported by Vaincre la Mucoviscidose (VLM), Assistance Publique – Hôpitaux de Paris, University Pierre et Marie Curie (Paris IV), INSERM, and Saime, Savigny le Temple, France.
The aim of the current study was to compare a clinical noninvasive method of setting up noninvasive pressure support ventilation (PS-NI) in young patients with cystic fibrosis (CF), based on parameters such as breathing frequency, arterial oxygen saturation and comfort rating, with a more invasive method (PS-I) targeted at optimising unloading of the inspiratory muscles and enhancing patient-ventilator synchronisation.
PS-NI and PS-I were compared in random order in 10 children with CF.
PS-NI differed from PS-I with regard to the level of inspiratory pressure (n=5), rate of inspiratory pressurisation (n=1), inspiratory trigger sensitivity (n=2) and expiratory trigger sensitivity (n=5). Although both methods modified breathing pattern, improved oxygen saturation and reduced diaphragmatic pressure time product (450±91 cmH2O·s–1·min–1 during spontaneous breathing, and 129±125 and 104±75 cmH2O·s–1·min–1 during PS-NI and PS-I, respectively), patient-ventilator synchrony and patient comfort were enhanced more during PS-I.
In young patients with cystic fibrosis, setting up pressure support using a clinical noninvasive approach based on easily measurable parameters, such as respiratory rate and comfort rating, is as effective as a more invasive technique based on unloading of the inspiratory muscles and optimising patient-ventilator synchronisation. However, whilst the standard clinical method is satisfactory in the majority of patients, more invasive measurements should be considered in patients who have difficulty synchronising with the ventilator to enhance patient tolerance and compliance.
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