Abstract
In spontaneous ventilation patient governs his breaths and the correct configuration of the mechanical ventilator is indispensable to avoid extra load in the ventilation process. Parameters like PEEP and pressure support (PS) affects directly the ventilatory comfort of the patient, therefore, they should be adjustable to improve oxygenation and reduce work of breathing (WOB). The objective of this study is to assess the WOB dynamics during incremental stimuli of PEEP and PS as additional information to the absolute WOB value. Variations of 2 cmH2O for 3 min up to 10 cmH2O for PEEP and PS separately were carried out in healthy subjects to analyze the changes in the WOB dynamics. 31 male adults were enrolled in this study, the absolute WOB, and three indexes of WOB dynamics (inspiratory slope, expiratory slope and ΔPeak) were calculated from ventilatory signals. Inspiratory slope shows a linear trend with the absolute WOB, nevertheless after the threshold of 0.8 J/L has a high dispersion, which suggests that high values of WOB could be obtained under different breathing pattern. In conclusion, the inspiratory slope like an index of WOB dynamics provides extra information that in future works could be compared with muscular and ventilator variables to identify positive or negative increases of WOB which clinicians could analyze to make decision about the optimum treatment of the patient.
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References
Ladeira, M.T., Vital, F.M.R., Andriolo, R.B., Andriolo, B.N.G., Atallah, A.N., Peccin, M.S.: Pressure support versus T tube for weaning from mechanical ventilation in adults (Review). Cochrane Database Syst. Rev. 5, 1–67 (2014). https://doi.org/10.1002/14651858.CD006056.pub2
Hernández, A.M., Salazar, M.B., Muñoz, I.C.: Efecto del incremento del PEEP en la actividad muscular respiratoria en sujetos sanos bajo ventilación espontánea. IATREIA 29(3), 280–291 (2016). https://doi.org/10.17533/udea.iatreia.v29n3a03
Peces-Barba, G.: Fisiopatología del atrapamiento aéreo en la EPOC. Rev. Patol. Respir. Patol. Respir. 8(2), 255–261 (2005)
Chikhani, M., Das, A., Haque, M., Wang, W., Bates, D.G., Hardman, J.G.: High PEEP in acute respiratory distress syndrome: Quantitative evaluation between improved arterial oxygenation and decreased oxygen delivery. Br. J. Anaesth. 117(5), 650–658 (2016). https://doi.org/10.1093/bja/aew314
Alotaibi, G.A.: Effect of pressure support level, patient’s effort, and lung mechanics on phase synchrony during pressure support ventilation. Middle East J Anaesthesiol. 22(6), 573–582 (2014)
Montaño, E.A., et al.: Utilidad del índice CROP como marcador pronóstico de extubación exitosa. Med. Interna Mex. 31(2), 164–173 (2015)
Figueroa, R.S., Hernández, F.A.: Ventilación mecánica en paciente con enfermedad pulmonar obstructiva crónica. Rev. Chil. Med. Intensiva. 27(1), 23–33 (2012)
Cabello, B., Mancebo, J.: Work of breathing. Intensive Care Med. 32(9), 1311–1314 (2006). https://doi.org/10.1007/s00134-006-0278-3
Akoumianaki, E., et al.: The application of esophageal pressure measurement in patients with respiratory failure. Am. J. Respir. Crit. Care Med. 189(5), 520–531 (2014). https://doi.org/10.1164/rccm.201312-2193CI
Kirton, O.C., DeHaven, C.B., Morgan, J.P., Windsor, J., Civetta, J.M.: Elevated imposed work of breathing masquerading as ventilator weaning intolerance. Chest 108(4), 1021–1025 (1995)
Teixeira, C., Zimermann, P.J., Pickersgill, P., Oliveira, E.S.: Work of breathing during successful spontaneous breathing trial. J. Crit. Care 24(4), 508–514 (2009). https://doi.org/10.1016/j.jcrc.2008.10.013
Bellani, G., et al.: Clinical assessment of auto-positive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist. Anesthesiology 121(3), 563–571 (2014)
Muñoz, I.C., Hernández, A.M.: Cambios en la mecánica ventilatoria debidos a variaciones de la PEEP y la presión soporte: estudio en sujetos sanos bajo ventilación mecánica no invasiva. Rev. Fac. Med. 65(2), 459–466 (2017). https://doi.org/10.15446.v65n2.60938
Fishman, C.L., Rodriguez, N.E.: The respiratory system. In: Egan’s Fundamentals of Respiratory Care, pp. 158–208 (2017)
Shen, D., Zhang, Q., Shi, Y.: Dynamic characteristics of mechanical ventilation system of double lungs with bi-level positive airway pressure model. Comput. Math. Methods Med. 2016, 1–13 (2016). https://doi.org/10.1155/2016/9234537
Serna, L.Y., Mañanas, M.A., Hernández, A.M., Rabinovich, R.A.: An improved dynamic model for the respiratory response to exercise. Front. Physiol. 9(69), 1–16 (2018). https://doi.org/10.3389/fphys.2018.00069
Acknowledgements
Research supported by Universidad de Antioquia through the Project code PRG-2015-7851 “Análisis de la actividad muscular respiratoria en ventilación mecánica no invasiva y su relación con la configuración del ventilador”.
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Ortega, Y.M., Muñoz, I.C., Hernández, A.M. (2018). Work of Breathing Dynamics Under Changes of PEEP and Pressure Support in Non-invasive Mechanical Ventilation. In: Figueroa-García, J., Villegas, J., Orozco-Arroyave, J., Maya Duque, P. (eds) Applied Computer Sciences in Engineering. WEA 2018. Communications in Computer and Information Science, vol 916. Springer, Cham. https://doi.org/10.1007/978-3-030-00353-1_36
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