Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury

Davide Chiumello, Paolo Pelosi, Paolo Taccone, Arthur Slutsky, Luciano Gattinoni

Research output: Contribution to journalArticle

Abstract

Objective: With many mechanical ventilators, it is possible to modify the time to reach the selected airway pressure and the criteria for cycling off the inflation during pressure support ventilation. This study evaluated the effect of different inspiratory rise time and cycling off criteria on breathing pattern and work of breathing. Design: Clinical study. Setting: University laboratory. Patients: Ten intubated patients recovering from acute lung injury (Pao2/Fl02 245 ± 26 torr, positive end-expiratory pressure 9 ± 3 cm H2O). Interventions: We studied two inspiratory rise time criteria (shortest and longest, 0% and 40% of the breath cycle time) and two cycling off criteria (lowest and highest, 5% and 40% of the peak inspiratory flow) at 5 and 15 cm H2O of pressure support. Respiratory rate, tidal volume, and inspiratory and expiratory work of breathing (WOBI and WOBE) were measured. Measurements and Main Results: At both levels of pressure support ventilation, the shortest inspiratory rise time significantly reduced the WOBI from 0.77 ± 0.32 to 0.56 ± 0.23 J/L and from 0.24 ± 0.28 to 0.08 ± 0.09 J/L without affecting respiratory rate or tidal volume. At 15 cm H2O of pressure support ventilation, the lowest cycling off criteria significantly reduced respiratory rate from 24.9 ± 12.1 to 21.5 ± 12.7 beats/min and increased tidal volume from 0.51 ± 0.17 to 0.60 ± 0.26 L. At both levels of pressure support ventilation, the modification of cycling off criteria did not influence WOBI and WOBE. Conclusions: Our results suggest that in patients recovering from acute lung injury during pressure support ventilation, a) the shortest inspiratory rise time reduces the WOBI; and b) at 15 cm H 2O of pressure support ventilation, the lowest cycling off criteria reduces the respiratory rate and increases the tidal volume without modifying the WOBI and WOBE. Modifications of inspiratory rise time and cycling off criteria must be carefully adjusted during pressure support ventilation.

Original languageEnglish
Pages (from-to)2604-2610
Number of pages7
JournalCritical Care Medicine
Volume31
Issue number11
DOIs
Publication statusPublished - Nov 2003

Fingerprint

Acute Lung Injury
Ventilation
Pressure
Tidal Volume
Respiratory Rate
Work of Breathing
Positive-Pressure Respiration
Economic Inflation
Mechanical Ventilators
Respiration

Keywords

  • Deadspace
  • Gas exchange
  • Neural inspiratory time
  • Patient
  • Ventilator synchrony
  • Work of breathing

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. / Chiumello, Davide; Pelosi, Paolo; Taccone, Paolo; Slutsky, Arthur; Gattinoni, Luciano.

In: Critical Care Medicine, Vol. 31, No. 11, 11.2003, p. 2604-2610.

Research output: Contribution to journalArticle

@article{4609f96311894e30bf3b6bdc827ca256,
title = "Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury",
abstract = "Objective: With many mechanical ventilators, it is possible to modify the time to reach the selected airway pressure and the criteria for cycling off the inflation during pressure support ventilation. This study evaluated the effect of different inspiratory rise time and cycling off criteria on breathing pattern and work of breathing. Design: Clinical study. Setting: University laboratory. Patients: Ten intubated patients recovering from acute lung injury (Pao2/Fl02 245 ± 26 torr, positive end-expiratory pressure 9 ± 3 cm H2O). Interventions: We studied two inspiratory rise time criteria (shortest and longest, 0{\%} and 40{\%} of the breath cycle time) and two cycling off criteria (lowest and highest, 5{\%} and 40{\%} of the peak inspiratory flow) at 5 and 15 cm H2O of pressure support. Respiratory rate, tidal volume, and inspiratory and expiratory work of breathing (WOBI and WOBE) were measured. Measurements and Main Results: At both levels of pressure support ventilation, the shortest inspiratory rise time significantly reduced the WOBI from 0.77 ± 0.32 to 0.56 ± 0.23 J/L and from 0.24 ± 0.28 to 0.08 ± 0.09 J/L without affecting respiratory rate or tidal volume. At 15 cm H2O of pressure support ventilation, the lowest cycling off criteria significantly reduced respiratory rate from 24.9 ± 12.1 to 21.5 ± 12.7 beats/min and increased tidal volume from 0.51 ± 0.17 to 0.60 ± 0.26 L. At both levels of pressure support ventilation, the modification of cycling off criteria did not influence WOBI and WOBE. Conclusions: Our results suggest that in patients recovering from acute lung injury during pressure support ventilation, a) the shortest inspiratory rise time reduces the WOBI; and b) at 15 cm H 2O of pressure support ventilation, the lowest cycling off criteria reduces the respiratory rate and increases the tidal volume without modifying the WOBI and WOBE. Modifications of inspiratory rise time and cycling off criteria must be carefully adjusted during pressure support ventilation.",
keywords = "Deadspace, Gas exchange, Neural inspiratory time, Patient, Ventilator synchrony, Work of breathing",
author = "Davide Chiumello and Paolo Pelosi and Paolo Taccone and Arthur Slutsky and Luciano Gattinoni",
year = "2003",
month = "11",
doi = "10.1097/01.CCM.0000089939.11032.36",
language = "English",
volume = "31",
pages = "2604--2610",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury

AU - Chiumello, Davide

AU - Pelosi, Paolo

AU - Taccone, Paolo

AU - Slutsky, Arthur

AU - Gattinoni, Luciano

PY - 2003/11

Y1 - 2003/11

N2 - Objective: With many mechanical ventilators, it is possible to modify the time to reach the selected airway pressure and the criteria for cycling off the inflation during pressure support ventilation. This study evaluated the effect of different inspiratory rise time and cycling off criteria on breathing pattern and work of breathing. Design: Clinical study. Setting: University laboratory. Patients: Ten intubated patients recovering from acute lung injury (Pao2/Fl02 245 ± 26 torr, positive end-expiratory pressure 9 ± 3 cm H2O). Interventions: We studied two inspiratory rise time criteria (shortest and longest, 0% and 40% of the breath cycle time) and two cycling off criteria (lowest and highest, 5% and 40% of the peak inspiratory flow) at 5 and 15 cm H2O of pressure support. Respiratory rate, tidal volume, and inspiratory and expiratory work of breathing (WOBI and WOBE) were measured. Measurements and Main Results: At both levels of pressure support ventilation, the shortest inspiratory rise time significantly reduced the WOBI from 0.77 ± 0.32 to 0.56 ± 0.23 J/L and from 0.24 ± 0.28 to 0.08 ± 0.09 J/L without affecting respiratory rate or tidal volume. At 15 cm H2O of pressure support ventilation, the lowest cycling off criteria significantly reduced respiratory rate from 24.9 ± 12.1 to 21.5 ± 12.7 beats/min and increased tidal volume from 0.51 ± 0.17 to 0.60 ± 0.26 L. At both levels of pressure support ventilation, the modification of cycling off criteria did not influence WOBI and WOBE. Conclusions: Our results suggest that in patients recovering from acute lung injury during pressure support ventilation, a) the shortest inspiratory rise time reduces the WOBI; and b) at 15 cm H 2O of pressure support ventilation, the lowest cycling off criteria reduces the respiratory rate and increases the tidal volume without modifying the WOBI and WOBE. Modifications of inspiratory rise time and cycling off criteria must be carefully adjusted during pressure support ventilation.

AB - Objective: With many mechanical ventilators, it is possible to modify the time to reach the selected airway pressure and the criteria for cycling off the inflation during pressure support ventilation. This study evaluated the effect of different inspiratory rise time and cycling off criteria on breathing pattern and work of breathing. Design: Clinical study. Setting: University laboratory. Patients: Ten intubated patients recovering from acute lung injury (Pao2/Fl02 245 ± 26 torr, positive end-expiratory pressure 9 ± 3 cm H2O). Interventions: We studied two inspiratory rise time criteria (shortest and longest, 0% and 40% of the breath cycle time) and two cycling off criteria (lowest and highest, 5% and 40% of the peak inspiratory flow) at 5 and 15 cm H2O of pressure support. Respiratory rate, tidal volume, and inspiratory and expiratory work of breathing (WOBI and WOBE) were measured. Measurements and Main Results: At both levels of pressure support ventilation, the shortest inspiratory rise time significantly reduced the WOBI from 0.77 ± 0.32 to 0.56 ± 0.23 J/L and from 0.24 ± 0.28 to 0.08 ± 0.09 J/L without affecting respiratory rate or tidal volume. At 15 cm H2O of pressure support ventilation, the lowest cycling off criteria significantly reduced respiratory rate from 24.9 ± 12.1 to 21.5 ± 12.7 beats/min and increased tidal volume from 0.51 ± 0.17 to 0.60 ± 0.26 L. At both levels of pressure support ventilation, the modification of cycling off criteria did not influence WOBI and WOBE. Conclusions: Our results suggest that in patients recovering from acute lung injury during pressure support ventilation, a) the shortest inspiratory rise time reduces the WOBI; and b) at 15 cm H 2O of pressure support ventilation, the lowest cycling off criteria reduces the respiratory rate and increases the tidal volume without modifying the WOBI and WOBE. Modifications of inspiratory rise time and cycling off criteria must be carefully adjusted during pressure support ventilation.

KW - Deadspace

KW - Gas exchange

KW - Neural inspiratory time

KW - Patient

KW - Ventilator synchrony

KW - Work of breathing

UR - http://www.scopus.com/inward/record.url?scp=0344442327&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0344442327&partnerID=8YFLogxK

U2 - 10.1097/01.CCM.0000089939.11032.36

DO - 10.1097/01.CCM.0000089939.11032.36

M3 - Article

C2 - 14605531

AN - SCOPUS:0344442327

VL - 31

SP - 2604

EP - 2610

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 11

ER -