title: In vitro assessment of the effect of proportional assist ventilation on the work of breathing.
abstract: During proportional assist ventilation, elastic and resistive unloading can be delivered to reduce the work of breathing (WOB). Our aim was to determine the effects of different levels of elastic and resistive unloading on the WOB in lung models designed to mimic certain neonatal respiratory disorders. Two dynamic lung models were used, one with a compliance of 0.4 ml/cm H2O to mimic an infant with respiratory distress syndrome and one with a resistance of 300 cm H2O/l/s to mimic an infant with bronchopulmonary dypslasia. Pressure volume curves were constructed at each unloading level. Elastic unloading in the low compliance model was highly effective in reducing the WOB measured in the lung model; the effective compliance increased from 0.4 ml/cm H2O at baseline to 4.1 ml/cm H2O at maximum possible elastic unloading (2.0 cm H2O/ml). Maximum possible resistive unloading (200 cm H2O/l/s) in the high-resistance model only reduced the effective resistance from 300 to 204 cm H2O/l/s. At maximum resistive unloading, oscillations appeared in the airway pressure waveform.
  
  
  CONCLUSIONS
  Our results suggest that elastic unloading will be helpful in respiratory conditions characterised by a low compliance, but resistive unloading as currently delivered is unlikely to be of major clinical benefit.
  
  
  BACKGROUND
  • During PAV, the ventilator can provide elastic and resistive unloading. What is New: • Elastic unloading was highly effective in reducing the work of breathing. • Maximum resistive unloading only partially reduced the effective resistance.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK.
authors.forename: Olie
authors.initials: O
authors.lastname: Chowdhury
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Bhat
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK.
authors.forename: Gerrard F
authors.initials: GF
authors.lastname: Rafferty
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Hannam
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Milner
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, SE5 9RS, UK. anne.greenough@kcl.ac.uk.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. anne.greenough@kcl.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D059725:Interactive Ventilatory Support / Q000379:methods*; D008170:Lung Compliance / Q000502:physiology; D008953:Models, Anatomic; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology; D014939:Work of Breathing / Q000502:physiology*
keywords: Elastic unloading; Lung models; Proportional assist ventilation; Resistive unloading; Work of breathing