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A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing
BACKGROUND: Poor patient-ventilator synchronization is often observed during pressure support ventilation (PSV) and has been associated with prolonged duration of mechanical ventilation and poor outcome. Diaphragmatic electrical activity (Eadi) recorded using specialized nasogastric tubes is a surro...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282691/ https://www.ncbi.nlm.nih.gov/pubmed/28137269 http://dx.doi.org/10.1186/s13054-017-1599-z |
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author | Beloncle, Francois Piquilloud, Lise Rittayamai, Nuttapol Sinderby, Christer Rozé, Hadrien Brochard, Laurent |
author_facet | Beloncle, Francois Piquilloud, Lise Rittayamai, Nuttapol Sinderby, Christer Rozé, Hadrien Brochard, Laurent |
author_sort | Beloncle, Francois |
collection | PubMed |
description | BACKGROUND: Poor patient-ventilator synchronization is often observed during pressure support ventilation (PSV) and has been associated with prolonged duration of mechanical ventilation and poor outcome. Diaphragmatic electrical activity (Eadi) recorded using specialized nasogastric tubes is a surrogate of respiratory brain stem output. This study aimed at testing whether adapting ventilator settings during PSV using a protocolized Eadi-based optimization strategy, or Eadi-triggered and -cycled assisted pressure ventilation (or PSV(N)) could (1) improve patient-ventilator interaction and (2) reduce or normalize patient respiratory effort as estimated by the work of breathing (WOB) and the pressure time product (PTP). METHODS: This was a prospective cross-over study. Patients with a known chronic pulmonary obstructive or restrictive disease, asynchronies or suspected intrinsic positive end-expiratory pressure (PEEP) who were ventilated using PSV were enrolled in the study. Four different ventilator settings were sequentially applied for 15 minutes (step 1: baseline PSV as set by the clinician, step 2: Eadi-optimized PSV to adjust PS level, inspiratory trigger, and cycling settings, step 3: step 2 + PEEP adjustment, step 4: PSV(N)). The same settings as step 3 were applied again after step 4 to rule out a potential effect of time. Breathing pattern, trigger delay (T(d)), inspiratory time in excess (T(iex)), pressure-time product (PTP), and work of breathing (WOB) were measured at the end of each step. RESULTS: Eleven patients were enrolled in the study. Eadi-optimized PSV reduced T(d) without altering T(iex) in comparison with baseline PSV. PSV(N) reduced T(d) and T(iex) in comparison with baseline and Eadi-optimized PSV. Respiratory pattern did not change during the four steps. The improvement in patient-ventilator interaction did not lead to changes in WOB or PTP. CONCLUSIONS: Eadi-optimized PSV allows improving patient ventilator interaction but does not alter patient effort in patients with mild asynchrony. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT 02067403. Registered 7 February 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1599-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5282691 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52826912017-02-03 A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing Beloncle, Francois Piquilloud, Lise Rittayamai, Nuttapol Sinderby, Christer Rozé, Hadrien Brochard, Laurent Crit Care Research BACKGROUND: Poor patient-ventilator synchronization is often observed during pressure support ventilation (PSV) and has been associated with prolonged duration of mechanical ventilation and poor outcome. Diaphragmatic electrical activity (Eadi) recorded using specialized nasogastric tubes is a surrogate of respiratory brain stem output. This study aimed at testing whether adapting ventilator settings during PSV using a protocolized Eadi-based optimization strategy, or Eadi-triggered and -cycled assisted pressure ventilation (or PSV(N)) could (1) improve patient-ventilator interaction and (2) reduce or normalize patient respiratory effort as estimated by the work of breathing (WOB) and the pressure time product (PTP). METHODS: This was a prospective cross-over study. Patients with a known chronic pulmonary obstructive or restrictive disease, asynchronies or suspected intrinsic positive end-expiratory pressure (PEEP) who were ventilated using PSV were enrolled in the study. Four different ventilator settings were sequentially applied for 15 minutes (step 1: baseline PSV as set by the clinician, step 2: Eadi-optimized PSV to adjust PS level, inspiratory trigger, and cycling settings, step 3: step 2 + PEEP adjustment, step 4: PSV(N)). The same settings as step 3 were applied again after step 4 to rule out a potential effect of time. Breathing pattern, trigger delay (T(d)), inspiratory time in excess (T(iex)), pressure-time product (PTP), and work of breathing (WOB) were measured at the end of each step. RESULTS: Eleven patients were enrolled in the study. Eadi-optimized PSV reduced T(d) without altering T(iex) in comparison with baseline PSV. PSV(N) reduced T(d) and T(iex) in comparison with baseline and Eadi-optimized PSV. Respiratory pattern did not change during the four steps. The improvement in patient-ventilator interaction did not lead to changes in WOB or PTP. CONCLUSIONS: Eadi-optimized PSV allows improving patient ventilator interaction but does not alter patient effort in patients with mild asynchrony. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT 02067403. Registered 7 February 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1599-z) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-31 /pmc/articles/PMC5282691/ /pubmed/28137269 http://dx.doi.org/10.1186/s13054-017-1599-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Beloncle, Francois Piquilloud, Lise Rittayamai, Nuttapol Sinderby, Christer Rozé, Hadrien Brochard, Laurent A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title | A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title_full | A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title_fullStr | A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title_full_unstemmed | A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title_short | A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
title_sort | diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282691/ https://www.ncbi.nlm.nih.gov/pubmed/28137269 http://dx.doi.org/10.1186/s13054-017-1599-z |
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