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Patient-ventilator interaction
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DOI：10.1164/ajrccm.163.5.2005125.png)
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Abstract
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One of the most frequent reasons for instituting mechanical ventilation is to decrease a patient's work of breathing. To achieve this goal, neuromuscular blockade was initially used to eliminate a patient's respiratory efforts, resulting in controlled ventilation. Neuromuscular blocking agents, however, predispose to numerous hazards, and, today, some means of assisted ventilation is usually employed. Surprisingly, we do not know the ideal level of respiratory muscle unloading during mechanical ventilation. To consider this issue, we need a means of measuring a patient's respiratory effort. Inspiratory pressure-time product (PTP), which quantifies swings in intrathoracic pressure, is closely related to oxygen cost of breathing and has several advantages over measurements of mechanical work of breathing (1), In 17 patients failing a trial of weaning from mechanical ventilation, their average PTP was 388 cm H2O . s/min (2); the average value in healthy subjects is 94 cm H2O . s/min. With carefully selected settings, a patient's inspiratory PTP can be reduced into the normal range with assisted ventilation (3). For the most effective unloading of the inspiratory muscles, the ventilator should cycle in synchrony with the activity of a patient's own respiratory rhythm. The interplay between these two pumps is complex, and problems can arise at several points in the respiratory cycle: the onset of ventilator triggering, the rest of inspiration after triggering, the switch from inspiration to expiration, and the end of expiration.
Keywords:
VARYING INSPIRATORY FLOW
PRESSURE SUPPORT VENTILATION
MECHANICAL VENTILATION
RESPIRATORY OUTPUT
BREATHING EFFORT
PULMONARY
FREQUENCY
DURATION
VOLUME
HUMANS
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