Intensive Care Medicine

, Volume 36, Issue 8, pp 1363–1370 | Cite as

Influence of ventilator settings on patient–ventilator synchrony during pressure support ventilation with different interfaces

  • R. Costa
  • P. Navalesi
  • G. Spinazzola
  • G. Ferrone
  • A. Pellegrini
  • F. Cavaliere
  • R. Proietti
  • M. Antonelli
  • G. Conti
Original

Abstract

Objective

To evaluate patient–ventilator interaction during pressure support ventilation (PSV) delivered with three interfaces [endotracheal tube (ET), face mask (FM), and helmet (H)] at different pressurization times (Timepress), cycling-off flow thresholds (Trexp), and respiratory rates (RR) in a bench study, and with FM and H in a healthy volunteers study.

Design

Bench study using a mannequin connected to an active lung simulator, and human study including eight healthy volunteers.

Measurements

PSV was delivered through the three interfaces with three different RR in the bench study, and through FM and H at two different RR in the human study. The mechanical and the neural RR, Ti, Te, inspiratory trigger delay (Delaytrinsp), pressurization time, and expiratory trigger delay were randomly evaluated at various ventilator settings (Timepress/Trexp: 50%/25%, default setting; 20%/5%, slow setting; 80%/60%, fast setting).

Results

Bench study: patient–ventilator synchrony was significantly better with ET, with lower Delaytrinsp and higher time of assistance (P < 0.001); the combination Timepress/Trexp 20%/5% at RR 30 produced the worst interaction, with higher rate of wasted efforts (WE) compared with Timepress/Trexp 80%/60% (20%, 40%, and 50% of WE versus 0%, 16%, and 26% of all spontaneous breaths, with ET, FM, and H, respectively; P < 0.01). In both studies, compared with H, FM resulted in better synchrony.

Conclusion

Patient–ventilator synchrony was significantly better with ET during the bench study; in the human study, FM outperformed H.

Keywords

Noninvasive ventilation Patient–ventilator interaction Pressurization rate Trigger Helmet Face mask Endotracheal tube 

Supplementary material

134_2010_1915_MOESM1_ESM.pdf (69 kb)
Supplementary material (PDF 69 kb)

References

  1. 1.
    Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S (2000) Physiologic evaluation of non-invasive mechanical ventilation delivered with three types of mask in patients with chronic hypercapnic respiratory failure. Crit Care Med 28:1785–1790CrossRefPubMedGoogle Scholar
  2. 2.
    Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient–ventilator asynchrony during non-invasive ventilation: the role of expiratory trigger. Intensive Care Med 25:662–667CrossRefPubMedGoogle Scholar
  3. 3.
    Antonelli M, Conti G, Rocco M, Bufi M, de Blasi RA, Vivino G, Gasparetto A, Gu Meduri (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435CrossRefPubMedGoogle Scholar
  4. 4.
    Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU (2002) Noninvasive versus conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 28:1701–1707CrossRefPubMedGoogle Scholar
  5. 5.
    Antonelli M, Conti G, Bufi M, Rocco M, Lappa A, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation. A randomized trial. JAMA 283:235–241CrossRefPubMedGoogle Scholar
  6. 6.
    Antonelli M, Conti G, Pelosi P, Gregoretti C, Pennisi M, Costa R, Proietti R (2002) New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet—a pilot controlled trial. Crit Care Med 30:602–608CrossRefPubMedGoogle Scholar
  7. 7.
    Costa R, Navalesi P, Antonelli M, Cavaliere F, Craba A, Proietti R, Conti G (2005) Physiologic evaluation of different levels of assistance during noninvasive ventilation delivered through a helmet. Chest 128:2984–2990CrossRefPubMedGoogle Scholar
  8. 8.
    Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G (2004) Noninvasive positive pressure ventilation using helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology 100:16–24CrossRefPubMedGoogle Scholar
  9. 9.
    Racca F, Appendini L, Gregoretti C, Stra E, Patessio A, Ranieri VM (2005) Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. J Appl Physiol 99:1262–1271CrossRefPubMedGoogle Scholar
  10. 10.
    Chiumello D, Pelosi P, Carlesso E, Severgnini P, Aspesi M, Gamberoni C, Antonelli M, Conti G, Chiaranda M, Gattinoni L (2003) Noninvasive positive pressure ventilation delivered by helmet versus standard face mask. Intensive Care Med 29:1671–1679CrossRefPubMedGoogle Scholar
  11. 11.
    Yamada Y, Du HL (2000) Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach. J Appl Physiol 88:2134–2150Google Scholar
  12. 12.
    Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424PubMedGoogle Scholar
  13. 13.
    Tassaux D, Gainnier M, Battisti A, Jolliet P (2005) Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med 172:1283–1289CrossRefPubMedGoogle Scholar
  14. 14.
    Chiumello D, Polli F, Tallarini F, Chierichetti M, Motta G, Azzari S, Colombo R, Rech R, Pelosi P, Raimondi F, Gattinoni L (2007) Effect of different cycling-off criteria and positive end-expiratory pressure during pressure support ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 35:2547–2552CrossRefPubMedGoogle Scholar
  15. 15.
    Chiumello D, Pelosi P, Taccone P, Slutsky A, Gattinoni L (2003) Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. Crit Care Med 31:2604–2610CrossRefPubMedGoogle Scholar
  16. 16.
    Prinianakis G, Delmastro M, Carlucci A, Ceriana P, Nava S (2004) Effect of varying the pressurisation rate during noninvasive pressure support ventilation. Eur Respir J 23:314–320CrossRefPubMedGoogle Scholar
  17. 17.
    Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMedGoogle Scholar
  18. 18.
    Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151:562–569PubMedGoogle Scholar
  19. 19.
    Navalesi P, Costa R, Ceriana P, Carlucci A, Prinianakis G, Antonelli M, Conti G, Nava S (2007) Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med 33:74–81CrossRefPubMedGoogle Scholar
  20. 20.
    Vargas F, Thille A, Lyazidi A, Campo FR, Brochard L (2009) Helmet with specific settings versus facemask for noninvasive ventilation. Crit Care Med 37:1921–1928CrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • R. Costa
    • 1
    • 3
  • P. Navalesi
    • 2
  • G. Spinazzola
    • 1
  • G. Ferrone
    • 1
  • A. Pellegrini
    • 1
  • F. Cavaliere
    • 1
  • R. Proietti
    • 1
  • M. Antonelli
    • 1
  • G. Conti
    • 1
  1. 1.Dipartimento di Anestesia e RianimazioneUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Terapia IntensivaSCDU Anestesia, Anestesia e Rianimazione GeneraleNovaraItaly
  3. 3.Department of Intensive Care and AnesthesiaCatholic University of RomeRomeItaly

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