Comparison of Inspiratory Effort, Workload and Cycling Synchronization Between Non-Invasive Proportional-Assist Ventilation and Pressure-Support Ventilation Using Different Models of Respiratory Mechanics

BACKGROUND: This study assessed lung models for the influence of respiratory mechanics and inspiratory effort on breathing pattern and simulator-ventilator cycling synchronization in non-invasive ventilation. MATERIAL/METHODS: A Respironics V60 ventilator was connected to an active lung simulator modeling mildly restrictive, severely restrictive, obstructive and mixed obstructive/restrictive profiles. Pressure-support ventilation (PSV) and proportional-assist ventilation (PAV) were set to obtain similar tidal volume (V(T)). PAV was applied at flow assist (FA) 40–90% of resistance (Rrs) and volume assist (VA) 40–90% of elastance (Ers). Measurements were performed with system air leak of 25–28 L/minute. Ventilator performance and simulator-ventilator asynchrony were evaluated. RESULTS: At comparable V(T), PAV had slightly lower peak inspiratory flow and higher driving pressure compared with PSV. Premature cycling occurred in the obstructive, severely restrictive and mildly restrictive models. During PAV, time for airway pressure to achieve 90% of maximum during inspiration (T90) in the severely restrictive model was shorter than those of the obstructive and mixed obstructive/restrictive models and close to that measured in the PSV mode. Increasing FA level reduced inspiratory trigger workload (PTP(300)) in obstructive and mixed obstructive/restrictive models. Increasing FA level decreased inspiratory time (T(I)) and tended to aggravate premature cycling, whereas increasing VA level attenuated this effect. CONCLUSIONS: PAV with an appropriate combination of FA and VA decreases work of breathing during the inspiratory phase and improves simulator-ventilator cycling synchrony. FA has greater impact than VA in the adaptation to inspiratory effort demand. High VA level might help improve cycling synchrony.