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01.09.2011 | Original

A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)

verfasst von: R. Costa, G. Spinazzola, F. Cipriani, G. Ferrone, O. Festa, A. Arcangeli, M. Antonelli, R. Proietti, G. Conti

Erschienen in: Intensive Care Medicine | Ausgabe 9/2011

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Abstract

Purpose

To compare patient–ventilator interaction during PSV and PAV+ in patients that are difficult to wean.

Methods

This was a physiologic study involving 11 patients. During three consecutive trials (PSV first trial—PSV1, followed by PAV+, followed by a second PSV trial—PSV2, with the same settings as PSV1) we evaluated mechanical and patient respiratory pattern; inspiratory effort from excursion Pdi (swing_Pdi), and pressure–time products of the transdiaphragmatic (PTPdi) pressures. Inspiratory (delay_trinsp) and expiratory (delay_trexp) trigger delays, time of synchrony (time_syn), and asynchrony index (AI) were assessed.

Results

Compared to PAV+, during PSV trials, the mechanical inspiratory time (Ti_flow) was significantly longer than patient inspiratory time (Ti_pat) (p < 0.05); Ti_pat showed a prolongation between PSV1 and PAV+, significant comparing PAV+ and PSV2 (p < 0.05). PAV+ significantly reduced delay_trexp (p < 0.001). The portion of tidal volume (VT) delivered in phase with Ti_pat (VT_pat/VT_mecc) was significantly higher during PAV+ (p < 0.01). The time of synchrony was significantly longer during PAV+ than during PSV (p < 0.001). During PSV 5 patients out of 11 showed an AI greater than 10%, whereas the AI was nil during PAV+.

Conclusion

PAV+ improves patient–ventilator interaction, significantly reducing the incidence of end-expiratory asynchrony and increasing the time of synchrony.

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Titel: A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)
verfasst von: R. Costa
G. Spinazzola
F. Cipriani
G. Ferrone
O. Festa
A. Arcangeli
M. Antonelli
R. Proietti
G. Conti
Publikationsdatum: 01.09.2011
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2011
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2297-y

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A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)