Pressure support ventilation (PSV) reverses hyperinflation induced isorhythmic A-V dissociation.
We report a case of hyperinflation induced isorythmic atrio-ventricular dissociation with circulatory failure in a patient with chronic obstructive pulmonary disease. The arrythmia was successfully treated by applying "pressure support ventilation" (PSV: 20 cmH2O) which, by decreasing the respiratory rate and increasing the expiratory time reduced the level of auto-PEEP. In order to explain this result the Authors recorded, in the same patient, the level of auto-PEEP and delta FRC obtained with Intermittent Positive Pressure Ventilation (IPPV), Intermittent Mandatory Ventilation (IMV) and PSV at the same gas exchange values. PSV showed a dramatic reduction of both these parameters. (Auto-PEEP: IPPV 12 cmH2O, IMV 17 cmH2O, PSV 7 cmH2O).
Conti
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Istituto di Anestesiologia e Rianimazione, Università La Sapienza, Roma, Italy.
Bufi
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Antonelli
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Rocco
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Gasparetto
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D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications; D008297:Male; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy