title: Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To investigate whether the level of initial flow rate alters the work of breathing in chronic obstructive pulmonary disease (COPD) patients ventilated in pressure support ventilation (PSV).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Medical ICU in University hospital.
  
  
  METHODS
  Eleven intubated COPD patients.
  
  
  METHODS
  We modulated the initial flow rate in order to achieve seven different sequences. In each sequence, the plateau pressure was reached within a predetermined time: 0.1, 0.25, 0.50, 0.75, 1, 1.25 or 1.50 s. The more rapidly the pressure plateau was achieved, the higher was the initial flow rate. In each patient, the pressure support level was an invariable parameter. The order of the seven sequences for each patient was determined randomly.
  
  
  RESULTS
  Ten minutes after application of each initial flow rate, we measured the following parameters: inspiratory work of breathing, electromyogram (EMG) of the diaphragm (EMGdi), breathing pattern, and intrinsic positive end-expiratory pressure (PEEPi). Comparison between the means for each sequence and each variable measured was performed by two-way analysis of variance with internal comparisons between sequences by Duncan's test. The reduction of the initial flow rate induced a progressive increase in the values of the work of breathing, EMGdi, and mouth occlusion pressure (P 0.1). In contrast, the reduction of the initial flow rate did not induce any significant change in tidal volume, respiratory frequency or PEEPi.
  
  
  CONCLUSIONS
  As the objective of PSV is to reduce the work of breathing, it seems logical to use the highest initial flow rate to induce the lowest possible work of breathing in COPD ventilated patients.
authors.affiliation: Intensive Care Unit, Hôpital Charles Nicolle, University of Rouen, France.
authors.forename: G
authors.initials: G
authors.lastname: Bonmarchand
authors.forename: V
authors.initials: V
authors.lastname: Chevron
authors.forename: C
authors.initials: C
authors.lastname: Chopin
authors.forename: D
authors.initials: D
authors.lastname: Jusserand
authors.forename: C
authors.initials: C
authors.lastname: Girault
authors.forename: F
authors.initials: F
authors.lastname: Moritz
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: P
authors.initials: P
authors.lastname: Pasquis
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004867:Equipment Design; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000502:physiology; D013997:Time Factors; D015300:Ventilator Weaning; D014939:Work of Breathing