Subject–ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2008-05-30

AUTHORS

Onnen Moerer, Jennifer Beck, Lukas Brander, Roberta Costa, Michael Quintel, Arthur S. Slutsky, Fabrice Brunet, Christer Sinderby

ABSTRACT

OBJECTIVE: Patient-ventilator synchrony during non-invasive pressure support ventilation with the helmet device is often compromised when conventional pneumatic triggering and cycling-off were used. A possible solution to this shortcoming is to replace the pneumatic triggering with neural triggering and cycling-off-using the diaphragm electrical activity (EA(di)). This signal is insensitive to leaks and to the compliance of the ventilator circuit. DESIGN: Randomized, single-blinded, experimental study. SETTING: University Hospital. PARTICIPANTS AND SUBJECTS: Seven healthy human volunteers. INTERVENTIONS: Pneumatic triggering and cycling-off were compared to neural triggering and cycling-off during NIV delivered with the helmet. MEASUREMENTS AND RESULTS: Triggering and cycling-off delays, wasted efforts, and breathing comfort were determined during restricted breathing efforts (<20% of voluntary maximum EA(di)) with various combinations of pressure support (PSV) (5, 10, 20 cm H(2)O) and respiratory rates (10, 20, 30 breath/min). During pneumatic triggering and cycling-off, the subject-ventilator synchrony was progressively more impaired with increasing respiratory rate and levels of PSV (p < 0.001). During neural triggering and cycling-off, effect of increasing respiratory rate and levels of PSV on subject-ventilator synchrony was minimal. Breathing comfort was higher during neural triggering than during pneumatic triggering (p < 0.001). CONCLUSIONS: The present study demonstrates in healthy subjects that subject-ventilator synchrony, trigger effort, and breathing comfort with a helmet interface are considerably less impaired during increasing levels of PSV and respiratory rates with neural triggering and cycling-off, compared to conventional pneumatic triggering and cycling-off. More... »

PAGES

1615-1623

References to SciGraph publications

  • 1999-07. Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger in INTENSIVE CARE MEDICINE
  • 2007-03. Improved Synchrony and Respiratory Unloading by Neurally Adjusted Ventilatory Assist (NAVA) in Lung-Injured Rabbits in PEDIATRIC RESEARCH
  • 2006-05-24. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis in CRITICAL CARE
  • 2004-01-22. Prolonged Neural Expiratory Time Induced by Mechanical Ventilation in Infants in PEDIATRIC RESEARCH
  • 2002-08-30. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial in INTENSIVE CARE MEDICINE
  • 2006-10-13. Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask in INTENSIVE CARE MEDICINE
  • 2006-04-28. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema – a systematic review and meta-analysis in CRITICAL CARE
  • 2002-02-06. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study in INTENSIVE CARE MEDICINE
  • 2003-08-28. Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study in INTENSIVE CARE MEDICINE
  • 2003-06-12. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask in INTENSIVE CARE MEDICINE
  • 1999-12. Neural control of mechanical ventilation in respiratory failure in NATURE MEDICINE
  • 2005-03-02. Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure in INTENSIVE CARE MEDICINE
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-008-1163-z

    DOI

    http://dx.doi.org/10.1007/s00134-008-1163-z

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/18512045


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    28 schema:description OBJECTIVE: Patient-ventilator synchrony during non-invasive pressure support ventilation with the helmet device is often compromised when conventional pneumatic triggering and cycling-off were used. A possible solution to this shortcoming is to replace the pneumatic triggering with neural triggering and cycling-off-using the diaphragm electrical activity (EA(di)). This signal is insensitive to leaks and to the compliance of the ventilator circuit. DESIGN: Randomized, single-blinded, experimental study. SETTING: University Hospital. PARTICIPANTS AND SUBJECTS: Seven healthy human volunteers. INTERVENTIONS: Pneumatic triggering and cycling-off were compared to neural triggering and cycling-off during NIV delivered with the helmet. MEASUREMENTS AND RESULTS: Triggering and cycling-off delays, wasted efforts, and breathing comfort were determined during restricted breathing efforts (<20% of voluntary maximum EA(di)) with various combinations of pressure support (PSV) (5, 10, 20 cm H(2)O) and respiratory rates (10, 20, 30 breath/min). During pneumatic triggering and cycling-off, the subject-ventilator synchrony was progressively more impaired with increasing respiratory rate and levels of PSV (p < 0.001). During neural triggering and cycling-off, effect of increasing respiratory rate and levels of PSV on subject-ventilator synchrony was minimal. Breathing comfort was higher during neural triggering than during pneumatic triggering (p < 0.001). CONCLUSIONS: The present study demonstrates in healthy subjects that subject-ventilator synchrony, trigger effort, and breathing comfort with a helmet interface are considerably less impaired during increasing levels of PSV and respiratory rates with neural triggering and cycling-off, compared to conventional pneumatic triggering and cycling-off.
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