title: Relationship between work of breathing provided by a ventilator and patients' inspiratory drive during pressure support ventilation; effects of inspiratory rise time.
abstract: Inspiratory drive and work of breathing provided by a ventilator (WOBv) during pressure support ventilation (PSV) were examined in 15 patients. At PSV 10 and 15 cm H2O during CPAP 5 cm H2O, patients with low P0.1 (<4.2 cm H2O, n=9) showed WOBv 0.57 and 0.92 J/l, those with high P0.1 (>4.2 cm H2O, n=6) showed 0.31 and 0.62 J/l respectively. WOBv was smaller and pressure-time product of oesophageal pressure (PTP) was significantly larger in high P0.1 patients. Peak inspiratory flow for low P0.1 patients increased as PSV level increased but high P0.1 patients showed no significant change. In a lung model, effects of inspiratory rise time (IRT) and PSV were studied at high and low inspiratory drives by using ventilators with (Servo 300) and without (Mallinckrodt 7200a) adjustable IRT. With 7200a, PSV 10 cm H2O during low drive was compared with PSV 10 and 15 cm H20 during high drive. In Servo 300, PSV 10 cm H2O (IRT 0.6 and 0.0 sec) during low drive was compared with PSV 10 cm H20 (IRT 0.6 and 0.0 sec) and PSV 15 cm H2O (IRT 0.6 sec) during high drive. Raising PSV and shortening IRT both increased peak inspiratory flow. Initial inspiratory flow increased in inverse proportion to IRT, but higher PSV had a little effect. WOBv with high drive was less than with low drive. Higher PSV preserved WOBv by increasing tidal volume. Shortening IRT recruited WOBv by increasing initial inspiratory flow without changing airway pressure and tidal volume. Compared with higher PSV, shorter IRT reduced PTP more. In conclusion, WOBv decreased as inspiratory drive increased due to inability to increase inspiratory flow. Increasing initial inspiratory flow was more effective than raising PSV to preserve inspiratory assistance of PSV at high inspiratory drive.
authors.affiliation: Intensive Care Unit, Osaka University Hospital, Yamadaoka, Suita, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Uchiyama
authors.forename: H
authors.initials: H
authors.lastname: Imanaka
authors.forename: N
authors.initials: N
authors.lastname: Taenaka
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012123:Pulmonary Ventilation; D012119:Respiration; D012121:Respiration, Artificial; D013990:Tidal Volume; D014939:Work of Breathing