Short-term effects of noisy pressure support ventilation in patients with acute hypoxemic respiratory failure

Peter M Spieth, Andreas Güldner, Robert Huhle, Alessandro Beda, Thomas Bluth, Dierk Schreiter, Max Ragaller, Birgit Gottschlich, Thomas Kiss, Samir Jaber, Paolo Pelosi, Thea Koch, Marcelo Gama de Abreu, Peter M Spieth, Andreas Güldner, Robert Huhle, Alessandro Beda, Thomas Bluth, Dierk Schreiter, Max Ragaller, Birgit Gottschlich, Thomas Kiss, Samir Jaber, Paolo Pelosi, Thea Koch, Marcelo Gama de Abreu

Abstract

Introduction: This study aims at comparing the very short-term effects of conventional and noisy (variable) pressure support ventilation (PSV) in mechanically ventilated patients with acute hypoxemic respiratory failure.

Methods: Thirteen mechanically ventilated patients with acute hypoxemic respiratory failure were enrolled in this monocentric, randomized crossover study. Patients were mechanically ventilated with conventional and noisy PSV, for one hour each, in random sequence. Pressure support was titrated to reach tidal volumes approximately 8 mL/kg in both modes. The level of positive end-expiratory pressure and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of pressure support during noisy PSV was set at 30%. Gas exchange, hemodynamics, lung functional parameters, distribution of ventilation by electrical impedance tomography, breathing patterns and patient-ventilator synchrony were analyzed.

Results: Noisy PSV was not associated with any adverse event, and was well tolerated by all patients. Gas exchange, hemodynamics, respiratory mechanics and spatial distribution of ventilation did not differ significantly between conventional and noisy PSV. Noisy PSV increased the variability of tidal volume (24.4 ± 7.8% vs. 13.7 ± 9.1%, P <0.05) and was associated with a reduced number of asynchrony events compared to conventional PSV (5 (0 to 15)/30 min vs. 10 (1 to 37)/30 min, P <0.05).

Conclusions: In the very short term, noisy PSV proved safe and feasible in patients with acute hypoxemic respiratory failure. Compared to conventional PSV, noisy PSV increased the variability of tidal volumes, and was associated with improved patient-ventilator synchrony, at comparable levels of gas exchange.

Trial registration: ClinicialTrials.gov, NCT00786292.

Figures

Figure 1
Figure 1
Hemodynamics and gas exchange. Hemodynamics and gas exchange during (conventional) pressure support ventilation (PSV) and noisy (variable) PSV. (A) Heart rate (HR); (B) mean arterial blood pressure (MAP); (C), ratio of arterial partial pressure of oxygen and inspired oxygen fraction (PaO2/FIO2); (D) arterial partial pressure of carbon dioxide (PaCO2).
Figure 2
Figure 2
Respiratory variables. Respiratory variables during (conventional) pressure support ventilation (PSV) and noisy (variable) PSV. (A) Mean pressure support (Δ pressure); (B) peak airway pressure (Paw peak); (C) mean airway pressure (Paw mean); (D) peak transpulmonary pressure (PL peak); (E) pressure time product (PTP); (F) minute ventilation (MV).
Figure 3
Figure 3
Variability, patient-ventilator asynchrony and regional distribution of ventilation. Variability, patient-ventilator asynchrony, and distribution of regional ventilation by electrical impedance tomography (EIT) during (conventional) pressure support ventilation (PSV) and noisy (variable) PSV. (A) coefficient of variation of tidal volume (CV VT); (B) asynchrony events; (C) percentage of ventilation assessed by electrical impedance tomography (EIT); *, P <0.05 vs. PSV. Data in panel A and C are presented as mean and standard deviation (SD), data in panel B as median and range. Two-way analysis of variance (ANOVA), paired t tests and Wilcoxon signed-rank tests were used as appropriate.

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