Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD
2016 | journal article. A publication with affiliation to the University of Göttingen.
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Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD
Moerer, O.; Harnisch, L.-O.; Herrmann, P.; Zippel, C. & Quintel, M. (2016)
Respiratory Care, 61(1) pp. 15-22. DOI: https://doi.org/10.4187/respcare.04141
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Details
- Authors
- Moerer, Onnen; Harnisch, Lars-Olav; Herrmann, Peter; Zippel, Carsten; Quintel, Michael
- Abstract
- BACKGROUND: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction. METHODS: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H2O) using the ventilator's invasive and NIV mode with and without an applied leakage. RESULTS: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001). CONCLUSION: Augmenting the cycling criterion above the default setting (20-30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.
- Issue Date
- 2016
- Status
- published
- Publisher
- Daedalus Enterprises Inc
- Journal
- Respiratory Care
- ISSN
- 1943-3654; 0020-1324