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Control of Breathing During Assisted Mechanical Ventilation

  • D. Georgopoulos
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1998)

Abstract

The respiratory control system consists of a motor arm which executes the act of breathing, a contol center located in the medulla and a number of mechanisms that convey information to the control center [1, 2]. Based on the information received, the control center activates spinal motor neurons subserving respiratory muscles, with an intensity and rate that varies substantially between breaths. The activity of the spinal motor neurons is conveyed, via peripheral nerves, to respiratory muscles, which contract and generate pressure (Pmus). Pmus is dissipated to overcome the resistance and elastance of the respiratory system (inertia is assumed to be negligible) and this combination determines volume-time profile and, thus, ventilation. Volume-time profile affects Pmus via force-length and force-velocity relationships of the respiratory muscles (mechanical feedback), whereas it modifies the activity of spinal motor neurons and the control center via afferents from various receptors located in the airways, chest wall or respiratory muscles (reflex feedback). Input generated from other sources (e.g., behavioral, temperature, postural) may also modify the function of the control center. On the other hand, ventilation and gas exchange properties of the lung determine arterial blood gases (PaO2, PaCO2), which, in turn, affect the activity of the control center, via peripheral and central chemoreceptors (chemical feedback). This briefly described complex system may be influenced at any level by various disease states as well as by therapeutic interventions.

Keywords

Respiratory Muscle Respir Crit Inspiratory Flow Breathing Frequency Inspiratory Effort 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Younes M, Remmers J (1981) Control of tidal volume and respiratory frequency. In: Hornbein TF (ed) Lung biology in health and disease, regulation of breathing. Marcel Dekker, New York, pp 621–671Google Scholar
  2. 2.
    Berger AJ (1988) Control of breathing. In: Murray and Nadel (eds) Textbook of respiratory medicine, W.B. Saunders, New York, pp 49–166Google Scholar
  3. 3.
    Georgopoulos D, Roussos C (1996) Control of breathing in mechanically ventilated patients. Eur Respir J, 9: 2151–2160PubMedCrossRefGoogle Scholar
  4. 4.
    Slutsky AS (1993) Mechanical ventilation. ACCP consensus conference. Chest 104: 1833 - 1859PubMedCrossRefGoogle Scholar
  5. 5.
    Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 145: 114–120CrossRefGoogle Scholar
  6. 6.
    Georgopoulos D, Anastasaki M, Katsanoulas K (1997) Effects of mechanical ventilation on control of breathing. Monaldi Arch Chest Dis 52: 253–262PubMedGoogle Scholar
  7. 7.
    Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Med 21: 522–536PubMedCrossRefGoogle Scholar
  8. 8.
    Younes M (1993) Patient-ventilator interaction with pressure-assisted modalities of ventilatory support. Sem Respir Med 14: 299–322CrossRefGoogle Scholar
  9. 9.
    Younes M (1995) Interactions between patients and ventilators. In: Roussos C (ed) Thorax, lung biology in health and disease, 2nd edn. Marcel Dekker, New York, pp 2367–2420Google Scholar
  10. 10.
    Fabry B, Guttmann J, Eberhard L, Bauer T, Haberthur C, Wolff G (1995) An analysis of desynchronization between the spontaneous breathing patient and ventilator during inspiratory pres-sure support. Chest 107: 1387–1394PubMedCrossRefGoogle Scholar
  11. 11.
    Rossi A, Appendini L (1995) Wasted efforts and dyssynchrony: is the patient-ventilator battle back? Intensive Care Med 21: 867–870PubMedCrossRefGoogle Scholar
  12. 12.
    Nava S, Bruschi C, Rubini F, Palo A, Iotti G, Braschi A (1995) Respiratory response and inspi-ratory effort during pressure support ventilation in COPD patients. Intensive Care Med 21: 871–879PubMedCrossRefGoogle Scholar
  13. 13.
    Georgopoulos D, Mitrouska I, Webster K, Bshouty Z, Younes M (1997) Effects of respiratory muscle unloading on the ventilatory response to CO2. Am J Respir Crit Care Med 155: 2000–2009PubMedGoogle Scholar
  14. 14.
    Younes M, Riddle W (1984) Relation between respiratory neural output and tidal volume. J Appl Physiol 56: 1110–1119PubMedGoogle Scholar
  15. 15.
    Younes M, Puddy A, Roberts D, et al (1992) Proportional assist ventilation. Results of an initial clinical trial. Am Rev Respir Dis 145: 121–129PubMedCrossRefGoogle Scholar
  16. 16.
    DeWeese EL, Sullivan TY, Yu PL (1984) Ventilatory and occlusion pressure responses to helium breathing. J Appl Physiol 54: 1525–1531Google Scholar
  17. 17.
    Hussain SNA, Pardy RL, Dempsey JA (1985) Mechanical impedance as determinant of inspira-tory neural driving during exercise in humans. J Appl Physiol 59: 365–375PubMedGoogle Scholar
  18. 18.
    Milic-Emili J, Tyler JM (1963) Relation between work output of respiratory muscles and end- tidal CO2 tension. J Appl Physiol 18: 497–504Google Scholar
  19. 19.
    Marini JJ, Smith TC, Lamb VJ (1988) External output and force generation during synchronized intermittent mechanical ventilation. Am Rev Respir Dis 138: 1169–1179PubMedGoogle Scholar
  20. 20.
    Imsand C, Feihl F, Perret C, Fitting JW (1994) Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation. Anesthesiology 80: 13–22PubMedCrossRefGoogle Scholar
  21. 21.
    Giuliani R, Mascia L, Recchia F, Caracciolo A, Fiore T, Ranieri VM (1995) Patient-ventilator in-teraction during synchronized intermittent mandatory ventilation. Am J Respir Crit Care Med 151: 1–9PubMedGoogle Scholar
  22. 22.
    Leung P, Jubran A, Tobin MJ (1997) Comparison of assisted ventilator mode on triggering, pa-tient effort, and dyspnea. Am J Respir Crit Care Med 155: 1940–1948PubMedGoogle Scholar
  23. 23.
    Patrick W, Webster K, Puddy A, Sanii R, Younes M (1995) Respiratory response to C02 in the hypocapnic range in conscious humans. J Appl Physiol 76: 2058–2086Google Scholar
  24. 24.
    Scheid P, Lofaso F, Isabey D, Harf A (1994) Respiratory response to inhaled C02 during positive inspiratory pressure in humans. J Appl Physiol 77: 876–882PubMedGoogle Scholar
  25. 25.
    Georgopoulos D, Mitrouska I, Bshouty Z, Webster K, Patakas D, Younes M (1997) Respiratory response to C02 during pressure support ventilation in conscious normal humans. Am J Respir Crit Care Med 156: 146–154PubMedGoogle Scholar
  26. 26.
    Rebuck AS, Rigg JRS, Saunders NA (1976) Respiratory frequency response to progressive iso- capnic hypoxia. J Physiol 258: 19–31PubMedGoogle Scholar
  27. 27.
    Hey EN, Lloyd BB, Cunningham DJC, Juke MGM, Bolton DPG (1966) Effects of various respiratory stimuli on the depth and frequency of breathing in man. Respir Physiol 1: 193–205PubMedCrossRefGoogle Scholar
  28. 28.
    Bechbache RR, Chow HHK, Duffin J, Orsini EC (1979) The effects of hypercapnia, hypoxia, exercise and anxiety on the pattern of breathing in man. J Physiol 293: 285–300PubMedGoogle Scholar
  29. 29.
    Gardner WN (1980) The pattern of breathing following step changes of alveolar partial pressures of carbon dioxide and oxygen in man. J Physiol 300: 55–73PubMedGoogle Scholar
  30. 30.
    Puntillo F, Grasso S, Fanelli G, et al (1997) Spontaneous variations of ventilatory requirements during mechanical ventilation: Pressure support vs proportional assist ventilation. Intensive Care Med 23 (suppl 1): S6 (Abst)Google Scholar
  31. 31.
    Georgopoulos D, Giannouli E, Tsara V, Argiropoulou P, Patakas D, Anthonisen NR (1992) Respi-ratory short-term poststimulus potentiation (after-discharge) in patients with obstructive sleep apnea. Am Rev Respir Dis 146: 1250–1255Google Scholar
  32. 32.
    Georgopoulos D, Bshouty Z, Younes M, Anthonisen NR (1990) Hypoxic exposure and activation of after-discharge mechanism in conscious humans. J Appl Physiol 69: 1159–1164PubMedGoogle Scholar
  33. 33.
    Georgopoulos D, Mitrouska I, Koletsos K, et al (1995) Post-stimulus ventilation in patients with brain damage. Am J Respir Crit Care Med 152: 1627–1632PubMedGoogle Scholar
  34. 34.
    Ranieri M, Giuliani R, Mascia L, et al (1996) Patient-ventilator interaction during acute hypercapnia: pressure-support vs. proportional-assist ventilation. J Appl Physiol 81: 426–436PubMedGoogle Scholar
  35. 35.
    Younes M (1989) The physiologic basis of central apnea. Cur Pulmonol 10: 265–326Google Scholar
  36. 36.
    Fink BR, Hanks EC, Ngai SH, Papper EM (1963) Central regulation of respiration during anesthesia and wakefulness. Ann NY Acad Sci 109: 892–899CrossRefGoogle Scholar
  37. 37.
    Skatrud JB, Dempsey JA (1983) Interaction of sleep state and chemical stimuli in sustaining rhythmic respiration. J Appl Physiol 55: 813–822PubMedGoogle Scholar
  38. 38.
    Morrell MJ, Shea SA, Adams L, Guz A (1993) Effects of inspiratory support uponbreathing during wakefulness and sleep. Respir Physiol 93: 57–70PubMedCrossRefGoogle Scholar
  39. 39.
    Datta AK, Shea SA, Horner RL, Guz A (1991) The influence of induced hypocapnia and sleep on the endogenous respiratory rhythm in humans. J Physiol 440: 17–33PubMedGoogle Scholar
  40. 40.
    Meza S, Giannouli E, Younes M (1995) Ventilatore response to inspiratory muscle unloading with PAV during sleep. Am J Respir Crit Care Med 153: A639 (Abst)Google Scholar
  41. 41.
    Rebuck AS, Slutsky AS (1986) Control of breathing in diseases of the respiratory tract and lungs. In: Cherniack NS, Widdicombe JC (eds) Handbook of physiology. The respiratory system, control of breathing, Vol. II, part 2. American Physiological Society, Bethesda, pp 771–791Google Scholar
  42. 42.
    Coleridge HM, Coleridge JCG (1986) Reflexes evoked from tracheobronchial tree and lungs. In: Cherniack NS, Widdicombe JC (eds) Handbook of physiology. The respiratory system, vol. 2. American Physiological Society, Bethesda, pp 395–430Google Scholar
  43. 43.
    Shannon R (1986) Reflexes evoked from respiratory muscles and cortovertebral joints. In: Cherniack NS, Widdicombe JG (eds) Handbook of physiology: The respiratory system, vol. 2. American Physiological Society, Bethesda, pp 431–438Google Scholar
  44. 44.
    Georgopoulos D, Mitrouska I, Bshouty Z, Webster K, Anthonisen NR, Younes M (1996) Effects of breathing route, temperature and volume of inspired gas and airway anesthesia on the response of respiratory output to varying inspiratory flow. Am J Respir Crit Care Med 153: 168–175PubMedGoogle Scholar
  45. 45.
    Georgopoulos D, Mitrouska I, Bshouty Z, Anthonisen NR, Younes M (1996) Effects of NREM sleep on the response of respiratory output to varying inspiratory flow. Am J Respir Crit Care Med 153: 1624–1630PubMedGoogle Scholar
  46. 46.
    Mitrouska I, Georgopoulos D, Younes M, Bshouty Z (1996) Effects of pulmonary and intercostal denervation on the response of respiratory output to varying inspiratory flow. Am Rev Respir Dis 153: A775 (Abst)Google Scholar
  47. 47.
    Georgopoulos, D, Mitrouska I, Markopoulou K, Patakas D, Anthonisen NR (1995) Effects of breathing patterns on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation. Intensive Care Med 21: 880–886PubMedCrossRefGoogle Scholar
  48. 48.
    Corne S, Gillespie D, Roberts D, Younes M (1997) Effect of inspiratory flow rate on respiratory rate in intubated ventilated patients. Am J Respir Crit Care Med 156: 304–308PubMedGoogle Scholar
  49. 49.
    Pierson DJ (1990) Complications of mechanical ventilation. Cur Pulmonol 11: 19–46Google Scholar
  50. 50.
    Manning HL, Molinary EJ, Leiter JC (1995) Effect of inspiratory flow rate on respiratory sensation and pattern of breathing. Am J Respir Crit Care Med 151: 751–757PubMedGoogle Scholar
  51. 51.
    Jubran A, Van De Graaf WB, Tobin M (1995) Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152: 129–136PubMedGoogle Scholar
  52. 52.
    O’Donnell DE (1994) Breathlessness in patients with chronic airflow limitation: mechanisms and management. Chest 106: 904–912PubMedCrossRefGoogle Scholar
  53. 53.
    Killian KJ, Campell EJM (1985) Dyspnea. In: Roussos C, Macklem PT (eds) The thorax. Lung biology in health and disease, vol. 29. Marcel Dekker, New York, pp 787–928Google Scholar
  54. 54.
    Altose MD (1986) Dyspnea. Cur Pulmonol 7: 199–226Google Scholar

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© Springer-Verlag Berlin Heidelberg 1998

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  • D. Georgopoulos

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