Pressure support, patient effort and tidal volume: a conceptual model for a non linear interaction.

Autor: Docci M; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada., Foti G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy., Brochard L; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada., Bellani G; Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy. giacomo.bellani@apss.tn.it.; Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy. giacomo.bellani@apss.tn.it.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Nov 06; Vol. 28 (1), pp. 358. Date of Electronic Publication: 2024 Nov 06.
DOI: 10.1186/s13054-024-05144-2
Abstrakt: Pressure support ventilation (PSV) is a form of assisted ventilation which has become frequently used, with the aim of partially unloading the patient's inspiratory muscles. Both under- and over-assistance should be avoided to target a lung- and diaphragm- protective ventilation. Herein, we propose a conceptual model, supported by actual data, to describe how patient and ventilator share the generation of tidal volume (Vt) in PSV and how respiratory system compliance (Crs) affects this interaction. We describe the presence of a patient-specific range of PSV levels, within which the inspiratory effort (Pmus) is modulated, keeping Vt relatively steady on a desired value (Vt target ). This range of assistance may be considered the "adequate PSV assistance" required by the patient, while higher and lower levels may result in over- and under-assistance respectively. As we also show, the determinants of over- and under- assistance borders depend on the combination of Crs and the inspiratory effort which the patient is able to sustain over a period of time. These concepts can be applied at the bedside to understand if the level of assistance is adequate to patient's demand, focusing on the variation of relevant parameters (Vt, Pmus and pressure-muscle-index) as patient reaction to a change in the level of assistance.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: