Effect of neurally adjusted ventilatory assist on trigger of mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease patients with intrinsic positive end-expiratory pressure
10.3760/cma.j.issn.0578-1426.2019.01.008
- VernacularTitle:神经调节辅助通气对存在内源性呼气末正压的慢性阻塞性肺疾病急性加重患者机械通气触发的影响
- Author:
Xiaoting XU
1
;
Qin SUN
;
Jianfeng XIE
;
Chun PAN
;
Yi YANG
;
Haibo QIU
;
Ling LIU
Author Information
1. 东南大学附属中大医院重症医学科
- Keywords:
Neurally adjusted ventilatory assist;
Pressure support ventilation;
Intrinsic positive end-expiratory pressure;
Acute exacerbation of chronic obstructive pulmonary disease;
Trigger delay;
Work of trigger
- From:
Chinese Journal of Internal Medicine
2019;58(1):43-48
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH2O (1 cmH2O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. Servo Tracker software continuously recorded the waveform of ventilator and respiratory mechanics indexes (including respiratory frequency, inspiratory tidal volume (Vti), minute ventilation volume (VE), peak airway pressure (PIP), inspiratory time), and calculated trigger and expiratory conversion delay time, work of trigger and total work of breath. Results A total of 14 AECOPD patients were enrolled with the average PEEPi (4.3±1.3) cmH2O. PSV inspiratory trigger delay time was positively correlated with PEEPi (r=0.913, P<0.05). Compared with PSV, NAVA significantly decreased trigger delay time in low, medium and high pressure level groups [(48±17) ms vs. (167±86) ms, (63±65) ms vs. (247±240) ms, (63±49) ms vs. (342±192) ms,respectively all P<0.05]. Similar results were shown as to work of trigger [(0.92±0.36) μV?s vs. (1.22±0.70) μV?s, (1.08±0.51) μV?s vs. (1.62 ± 1.25) μV?s, (1.20 ± 0.96) μV?s vs. (2.29 ± 1.02) μV?s, all P<0.05]. Trigger delay time increased according to the increase of pressure level in PSV mode.Conclusion The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.
