title: Timing of pressure release affects power of breathing and minute ventilation during airway pressure release ventilation.
abstract: OBJECTIVE
  To evaluate the effects of interference between spontaneous and mechanical breaths on the power of breathing (rate at which work is done) and ventilatory support during airway pressure release ventilation.
  
  
  METHODS
  Multitrial tests under simulated clinical conditions using a mechanical respiratory system model.
  
  
  METHODS
  A research laboratory at a university medical center.
  
  
  METHODS
  Simulated spontaneous breathing augmented with continuous positive airway pressure and airway pressure release ventilation. Variation in synchrony between spontaneous breathing and mechanical ventilation was accomplished by adjusting the time lag between detection of the spontaneous inspiration and the airway pressure release from 0 to 3 secs in increments of 0.25 secs.
  
  
  RESULTS
  Pressures and volumes were measured at the inlet of the lung and chest wall compartment of the respiratory system model. Pressure and volume changes measured at the inlet of the chest wall compartment were used to generate pressure/volume loops and to calculate the power of the spontaneous breathing. Minute ventilation was greater (p < .01) during all airway pressure release ventilation settings compared with those values of continuous positive airway pressure. Nonconflicting airway pressure release ventilation was associated with a higher minute ventilation (p < .001) than asynchronous airway pressure release ventilation. When spontaneous inspiration was synchronous with restoration of continuous positive airway pressure, minute ventilation was lower (p < .001) than during nonconflicting airway pressure release ventilation settings. Power of spontaneous breathing was highest when airway pressure release and spontaneous inspiration coincided, and lowest when spontaneous inspiration and restoration of continuous positive airway pressure were synchronized. Power of breathing was significantly lower during nonconflicting than during asynchronous airway pressure release ventilation (p < .01). No difference was observed between the power of spontaneous breathing and airway pressure release ventilation either with spontaneous expiration synchronized with airway pressure release or with nonconflicting airway pressure release ventilation. When calculated per liter of ventilation, power of spontaneous breathing was significantly lower (p < .01) during all airway pressure release ventilation settings compared with continuous positive airway pressure.
  
  
  CONCLUSIONS
  Asynchronous airway pressure release may increase the power of spontaneous breathing and reduce effective mechanical ventilatory support during airway pressure release ventilation. A clinical study is required to assess the effect of synchronous and asynchronous interference between spontaneous and mechanical breaths during airway pressure release ventilation.
authors.affiliation: Department of Anesthesiology, University of South Florida College of Medicine, Tampa 33612-4799.
authors.forename: C
authors.initials: C
authors.lastname: Putensen
authors.forename: M A
authors.initials: MA
authors.lastname: León
authors.forename: G
authors.initials: G
authors.lastname: Putensen-Himmer
mesh_terms: D000403:Airway Resistance; D000704:Analysis of Variance; D005069:Evaluation Studies as Topic; D006801:Humans; D008954:Models, Biological; D011175:Positive-Pressure Respiration / Q000379:methods*; D012119:Respiration; D013997:Time Factors; D014939:Work of Breathing