title: Positive pressure versus pressure support ventilation at different levels of PEEP using the ProSeal laryngeal mask airway.
abstract: We compared positive pressure ventilation with pressure support ventilation at different levels of positive end expiratory pressure (PEEP) using the ProSeal laryngeal mask airway (PLMA). Forty-two anaesthetized adults (ASA 1-2, aged 19 to 63 years) underwent positive pressure ventilation and then pressure support ventilation each with PEEP set at 0, 5 and 10 cmH2O in random order. Pressure support ventilation was with the inspired tidal volume (VTInsp) set at 7 ml/kg and the respiratory rate adjusted to maintain the end-tidal CO2 (ETCO2) at 40 mmHg. Pressure support ventilation was with pressure support set at 5 cmH2O above PEEP and initiated when inspiration produced a 2 cmH2O reduction in airway pressure. Tidal volumes were similar during positive pressure and pressure support ventilation with PEEP, but were higher for the former without PEEP Respiratory rate and peak inspiratory flow rate were higher during pressure support than positive pressure ventilation (all P < 0.001). Peak airway pressure (Ppaw), mean airway pressure (Mpaw), peak expiratory flow rate, and expired airway resistance were lower during pressure support than positive pressure ventilation (all P < 0.001). With PEEP set at 10 cmH2O, ETCO2 was lower for pressure support than positive pressure ventilation. During positive pressure ventilation, there was an increase in Ppaw, Mpaw and dynamic compliance (Cdyn) with increasing levels of PEEP (all P < 0.01). During pressure support ventilation, there was an increase in inspired and expired tidal volume, Ppaw, peak inspiratory and expiratory flow rates and Cdyn, and a reduction in ETCO2, work of breathing, and expired airway resistance with increasing levels of PEEP (all P < 0.01). There were no differences in SpO2, non-invasive mean arterial pressure, heart rate or leak fraction. We conclude that pressure support ventilation provides equally effective gas exchange as positive pressure ventilation during PLMA anaesthesia with or without PEEP at the tested settings. During pressure support, PEEP increases ventilation and reduces work on breathing without increasing leak fraction.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: von Goedecke
authors.forename: J
authors.initials: J
authors.lastname: Brimacombe
authors.forename: C
authors.initials: C
authors.lastname: Keller
authors.forename: C
authors.initials: C
authors.lastname: Hoermann
authors.forename: A
authors.initials: A
authors.lastname: Loeckinger
authors.forename: J
authors.initials: J
authors.lastname: Rieder
authors.forename: A
authors.initials: A
authors.lastname: Kleinsasser
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods; D011175:Positive-Pressure Respiration; D011336:Probability; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome