Effects of different levels of pressure support variability on acute respiratory distress syndrome

doi:10.3877/cma.j.issn.2095-9133.2016.05.004

Abstract

Abstract:

Objective

To compare the effects of different levels of variability duringnoisy pressure support ventilation (noisy PSV) in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).

Methods

Seventeen patients with ARDS were enrolled in this monocentric, randomized crossover study. All patients were mechanically ventilated with different levels of noisy PSV for 10 minutes respectively, in random sequence.The subjects, such as gas exchange, lung functional parametersand distribution of ventilation by electrical impedancetomography(EIT), were obtained and analyzed.

Results

Oxygenation index(PaO₂/FiO₂)had no significant difference between groups of different levels(P>0.05). But intragroup analysis indicated that PaO₂/FiO₂ was improved by noisy PSV 30% in comparison with 15% (P<0.05). Respiratory mechanics did not differ significantly among different levels of noisy PSV (P>0.05). Spatial distribution of ventilation in regions of interet 1-4 showed no difference with different levels of noisy PSV(P>0.05). But intragroup analysis still showed that ventilation in ROI3 was significantly improved by noisy PSV30% as compared with 15%(P<0.05).

Conclusion

Compared to the level of 15%, noisy PSV 30% is associated with better gas exchange and improved distribution of ventilation.

Key words: noisy PSV, ARDS, Variability, Distribution, Inhomogeneity

Shuangxian Guan, Xin Zhang, Lingling Zhang, Dongliang Ding, Wenbo Xu, Songqiao Liu, Guoming Li. Effects of different levels of pressure support variability on acute respiratory distress syndrome[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 02(05): 276-279.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2016.05.004

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2016/V02/I05/276

Figures/Tables 3

References 15

1	Force ADT, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533.
2	Yoshida T, Uchiyama A, Matsuura N, et al.The comparison of spontaneous breathing and muscle paralysis in two different severities of experimental lung injury[J]. Crit Care Med, 2013, 41(2): 536-545.
3	付守芝，陆辉志，杨璐瑜，等．优先气管插管抢救中毒所致呼吸衰竭患者30例体会[J/CD]．中华卫生应急电子杂志，2015，1(5)：370-371.
4	Gama de Abreu M, Spieth PM, Pelosi P, et al.Noisy pressure support ventilation: a pilot study on a new assisted ventilation mode in experimental lung injury[J]. Crit Care Med, 2008, 36(3): 818-827.
5	Spieth PM, Carvalho AR, Pelosi P, et al.Variable tidal volumes improve lung protective ventilation strategies in experimental lung injury[J]. Am J Respir Crit Care Med, 2009, 179(8): 684-693.
6	Lefevre GR, Kowalski SE, Girling LG, et al.Improved arterial oxygenation after oleic acid lung injury in the pig using a computer-controlled mechanical ventilator[J]. Am J Respir Crit Care Med, 1996, 154(5): 1567-1572.
7	Spieth PM, Güldner A, Beda A, et al.Comparative effects of proportional assist and variable pressure support ventilation on lung function and damage in experimental lung injury[J]. Crit Care Med, 2012, 40(9): 2654-2661.
8	Spieth PM, Carvalho AR, Guldner A, et al.Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support[J]. Crit Care Med, 2011, 39(4): 746-755.
9	Tobin MJ, Mador MJ, Guenther SM, et al.Variability of resting respiratory drive and timing in healthy subjects[J]. J Appl Physiol, 1988, 65(1): 309-317.
10	Colombo D, Cammarota G, Bergamaschi V, et al.Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure[J]. Intensive Care Med, 2008, 34(11): 2010-2018.
11	Spieth PM, Carvalho AR, Güldner A, et al.Effects of different levels of pressure support variability in experimental lung injury[J]. Anesthesiology, 2009, 110(2): 342-350.
12	Suki B, Alencar AM, Sujeer MK, et al.Life-support system benefits from noise[J]. Nature, 1998, 393(6681): 127-128.
13	朱宇，张谦．早期目标导向型镇静用于ICU机械通气患者的临床观察[J/CD]．中华卫生应急电子杂志，2016，2(1)：43-45.
14	Bellardine CL, Hoffman AM, Tsai L, et al.Comparison of variable and conventional ventilation in a sheep saline lavage lung injury model[J]. Crit Care Med, 2006, 34(2): 439-445.
15	Brewster JF, Graham MR, Mutch WA.Convexity, Jensen’s inequality and benefits of noisy mechanical ventilation[J]. J R Soc Interface, 2005, 2(4): 393-396.

通气模式	例数	RR(次/min)	PEEP(mmHg)	PIP(mmHg)	TV(mL)
noisy PSV 15%	17	16.18±6.25	9.00±2.93	22.05±5.71	428.27±131.08
noisy PSV 30%	17	15.96±6.00	8.80±3.05	21.85±5.77	443.45±130.88
noisy PSV 45%	17	15.92±5.46	8.91±2.00	22.06±5.63	436.70±118.87
F值	?	0.009	0.018	0.007	0.057
P值	?	>0.05	>0.05	>0.05	>0.05

通气模式	例数	RR(次/min)	PEEP(mmHg)	PIP(mmHg)	TV(mL)
noisy PSV 15%	17	16.18±6.25	9.00±2.93	22.05±5.71	428.27±131.08
noisy PSV 30%	17	15.96±6.00	8.80±3.05	21.85±5.77	443.45±130.88
noisy PSV 45%	17	15.92±5.46	8.91±2.00	22.06±5.63	436.70±118.87
F值	?	0.009	0.018	0.007	0.057
P值	?	>0.05	>0.05	>0.05	>0.05

通气模式	例数	PaO₂/FiO₂	PaCO₂(mmHg)
noisy PSV 15%	17	305.34±100.65	33.78±9.47
noisy PSV 30%	17	328.66±98.84^a	33.28±8.65
noisy PSV 45%	17	316.75±100.67	32.94±9.31
F值	?	0.231	0.037
P值	?	>0.05	>0.05

通气模式	例数	PaO₂/FiO₂	PaCO₂(mmHg)
noisy PSV 15%	17	305.34±100.65	33.78±9.47
noisy PSV 30%	17	328.66±98.84^a	33.28±8.65
noisy PSV 45%	17	316.75±100.67	32.94±9.31
F值	?	0.231	0.037
P值	?	>0.05	>0.05

通气模式	例数	ROI 1	ROI 2	ROI 3	ROI 4
noisy PSV 15%	17	11.5±3.6	45.9±9.4	36.5±9.0	6.2±5.2
noisy PSV 30%	17	11.3±4.2	43.7±9.5	38.8±10.5^a	6.2±5.1
noisy PSV 45%	17	11.6±3.9	45.4±10.6	37.2±10.8	5.9±4.7
F值	?	0.029	0.219	0.222	0.021
P值	?	>0.05	>0.05	>0.05	>0.05

Please choose a citation manager

Content to export