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Published on: July 9, 2020
Ventilator waveforms and the physiology of pressure support ventilation
1Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. dhess@partners.org
Pressure support ventilation (PSV) can improve patient-ventilator synchrony. Adjusting ventilator settings like rise time and flow termination optimizes delivered tidal volume and patient comfort during mechanical ventilation.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Mechanical Ventilation
Background:
- Pressure support ventilation (PSV) is a widely utilized patient-triggered, pressure-limited, and flow-cycled mechanical ventilation mode.
- Challenges in triggering PSV are often linked to intrinsic positive end-expiratory pressure (PEEP).
- Optimizing airway pressure and flow delivery is crucial for effective PSV.
Purpose of the Study:
- To explore the impact of ventilator settings on patient-ventilator synchrony during PSV.
- To highlight the role of clinician-adjustable parameters in PSV.
- To emphasize the utility of ventilator waveforms in PSV adjustment.
Main Methods:
- Analysis of pressure support ventilation (PSV) mechanics, including triggering, pressure generation, and flow cycling.
- Examination of how clinician-adjustable settings (pressure support, rise time, flow termination) influence ventilation.
- Review of ventilator waveform interpretation for optimizing PSV.
Main Results:
- Inadequate triggering in PSV can stem from intrinsic positive end-expiratory pressure.
- Delivered tidal volume in PSV is contingent on pressure support, patient effort, and respiratory system mechanics.
- Patient-ventilator dyssynchrony can arise if ventilator cycling doesn't align with neural inspiratory termination.
Conclusions:
- Adjustable rise time and flow-termination settings on modern ventilators can mitigate patient-ventilator asynchrony during PSV.
- Understanding ventilator waveforms is essential for fine-tuning PSV settings.
- Optimizing PSV enhances patient comfort and ventilation effectiveness.
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