Comparison of pressure- and flow-triggered pressure-support ventilation on weaning parameters in patients recovering from acute respiratory failure.
OBJECTIVE
To compare the effects of pressure- and flow-triggered pressure-support ventilation on weaning parameters during recovery from acute respiratory failure.


METHODS
Prospective, randomized, clinical trial.


METHODS
Intensive care unit in a university hospital.


METHODS
Sixteen orotracheally intubated adult patients recovering from acute respiratory failure of various etiologies, without chronic obstructive pulmonary disease.


METHODS
Randomized application of pressure- and flow-triggered pressure-support ventilation at 100% and 75% ventilatory support levels in each triggering system. A total of four conditions were applied for 30 mins each in all patients.


RESULTS
Ventilatory, respiratory, and hemodynamic data were measured. For the measurement of weaning parameters, pressure and volume signals were directed to a computerized respiratory monitor by means of an esophageal probe and a flow sensor between the "Y" piece of the ventilatory circuit and the endotracheal tube. During both pressure-triggered (trigger sensitivity of -1 cm H2O) and flow-triggered (trigger sensitivity of 0.7 to 2.0 L/min) pressure-support ventilation with a ventilator, peak airway pressures were applied so as to decrease the work of breathing performed by the patient to zero (full ventilatory support). Partial ventilatory support was applied at 75% of the peak airway pressures achieved during full ventilatory support with each triggering system. A total of four experimental conditions were evaluated at identical FiO2 and positive and-expiratory pressure levels during pressure-support ventilation in each patient. Total ventilation volumes, arterial blood gas data, and hemodynamics did not differ among the four experimental conditions. During partial ventilatory support, the work of breathing, rapid shallow breathing index, and esophageal pressure increased significantly with both triggering systems when compared with data obtained at full ventilatory support. The mean data for the weaning parameters during the condition of partial ventilatory support were comparable between pressure- and flow-triggered pressure-support ventilation (i.e., 0.38 +/- 0.24 vs. 0.42 +/- 0.26 joule/L for work of breathing, 2.6 +/- 1.6 vs. 3.3 +/- 1.7 cm H2O for tracheal occlusion pressure, and 40.2 +/- 12.9 vs. 50.4 +/- 18.3 breaths/min/L for rapid shallow breathing index, respectively).


CONCLUSIONS
The application of either a pressure- or flow-triggered system during pressure-support ventilation with the ventilator did not significantly affect short-term changes in gas exchange, respiratory mechanics, and inspiratory workload in patients recovering from acute respiratory failure of various etiologies without chronic obstructive pulmonary disease.
Tütüncü
A S
AS
Department of Anesthesiology and Intensive Care, Medical Faculty, University of Istanbul, Turkey.
Cakar
N
N
Camci
E
E
Esen
F
F
Telci
L
L
Akpir
K
K
D018806:APACHE; D000328:Adult; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D015300:Ventilator Weaning; D014939:Work of Breathing