Validation of a Proposed Algorithm for Assistance Titration During Proportional Assist Ventilation With Load-Adjustable Gain Factors.

Autor: Amargiannitakis V; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Gialamas I; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Pediaditis E; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Soundoulounaki S; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Prinianakis G; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Vaporidi K; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Akoumianaki E; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Proklou A; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Alexopoulou C; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Georgopoulos D; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece., Kondili E; Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece. kondylie@uoc.gr.
Jazyk: angličtina
Zdroj: Respiratory care [Respir Care] 2020 Jan; Vol. 65 (1), pp. 36-44. Date of Electronic Publication: 2019 Sep 17.
DOI: 10.4187/respcare.06988
Abstrakt: Background: The present study aimed to validate a recently proposed algorithm for assistance titration during proportional assist ventilation with load-adjustable gain factors, based on a noninvasive estimation of maximum inspiratory pressure (peak P mus ) and inspiratory effort (pressure-time product [PTP] peak P mus ).
Methods: Retrospective analysis of the recordings obtained from 26 subjects ventilated on proportional assist ventilation with load-adjustable gain factors under different conditions, each considered as an experimental case. The estimated inspiratory output (peak P mus ) and effort (PTP-peak P mus ) were compared with the actual-determined by the measurement of transdiaphragmatic pressure- and the derived PTP. Validation of the algorithm was performed by assessing the accuracy of peak P mus in predicting the actual inspiratory muscle effort and indicating the appropriate level of assist.
Results: In the 63 experimental cases analyzed, a limited agreement was observed between the estimated and the actual inspiratory muscle pressure (-11 to 10 cm H 2 O) and effort (-82 to 125 cm H 2 O × s/min). The sensitivity and specificity of peak P mus to predict the range of the actual inspiratory effort was 81.2% and 58.1%, respectively. In 49% of experimental cases, the level of assist indicated by the algorithm differed from that indicated by the transdiaphragmatic pressure and PTP.
Conclusions: The proposed algorithm had limited accuracy in estimating inspiratory muscle effort and with indicating the appropriate level of assist.
Competing Interests: Drs Amargiannitakis and Gialamas contributed equally to this work. Drs Kondili, Vaporidi, and Georgopoulos have received lecture fees (honoraria) from Covidien.
(Copyright © 2020 by Daedalus Enterprises.)
Databáze: MEDLINE
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