Chest
Clinical Investigations in Critical CareAn Analysis of Desynchronization Between the Spontaneously Breathing Patient and Ventilator During Inspiratory Pressure Support
Section snippets
Methods
Patients suffering from a variety of critical illnesses requiring mechanical ventilation due to ARI (Table 1) were included in our study when the ventilatory mode was switched from mechanical ventilation to IPS. This was done when the patient showed spontaneous breathing efforts being sufficient enough to be able to trigger the ventilator and to maintain a sufficient ventilation at pressure support levels below 20 mbar, independent of PEEP or fraction of inspiratory oxygen (FI02). When FI02 was
Results
Table 1 lists clinical data of all patients and their ventilatory situation. We found desynchronization of several levels of severity in 9 of the 11 patients with ARI studied.
Figure 1 shows the course of desynchronization over time in all patients who displayed desynchronization. Figure 1 contains the results for all data recordings.
The following results analyze and explain in detail our findings in relation to patient 1. Figure 2 shows gas flow, volume, airway pressure, intratracheal pressure,
Discussion
The main advantage of patient-triggered IPS over other modes of assisted spontaneous breathing is that the patient controls inspiratory and expiratory time. Therefore, IPS is expected to increase the patient's breathing comfort and synchrony with a ventilator.1 Ideally, the ventilator would provide pressure support in the airways during the entire inspiratory effort, and on completion of the patient's inspiratory effort, the airway pressure would then be reduced to PEEP level.1 In practice,
Acknowledgment
Professor Gunther Wolff died unexpectedly on October 24th, 1994. He was one of the pioneers in the field of intensive care medicine and dedicated a major part of his scientific career to research of mechanical ventilation and lung pathophysiology. Dr. Wolff's energy and enthusiasm, his innovative ideas, and his personality are irreplaceable.
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Presented in part at the joint annual meeting of the Swiss Society of Pneumology and the Swiss Society of Intensive Care Medicine, Lugano, October 7–9, 1993
Supported by the Swiss National Science Foundation 3239382.93.
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Deceased. Please see the acknowledgment on page 1394.