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The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis
1Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland.
Volume-controlled synchronised intermittent mandatory ventilation (VC-SIMV) mode settings are more effective for achieving successful ventilator hyperinflations in intensive care airway clearance compared to other modes. This finding aids physiotherapists in optimizing mechanical ventilation strategies.
Area of Science:
- Mechanical Ventilation
- Respiratory Physiology
- Intensive Care Medicine
Background:
- Physiotherapists utilize ventilator hyperinflations for airway clearance in intensive care units.
- Limited data exists on optimal mechanical ventilator modes and settings for achieving desired flow patterns during hyperinflation.
Purpose of the Study:
- To evaluate the effectiveness of different mechanical ventilator modes and settings for achieving successful ventilator hyperinflation.
- To identify optimal ventilator parameters for airway clearance in intensive care.
Main Methods:
- A mechanical ventilator was connected to lung simulators and a respiratory mechanics monitor.
- Peak inspiratory and expiratory flow rates were measured across various ventilator modes (PSV, VC-SIMV, PC-SIMV) and settings.
- Trials were conducted with high and low lung simulator compliance, and success was defined by specific flow rate criteria.
Main Results:
- Volume-controlled synchronised intermittent mandatory ventilation (VC-SIMV) trials were more successful in meeting all outcome measures compared to pressure support ventilation (PSV) and pressure-controlled synchronised intermittent mandatory ventilation (PC-SIMV).
- VC-SIMV mode showed a higher proportion of successful trials (26) versus PC-SIMV (7) and PSV (0).
- A higher percentage of VC-SIMV trials were stopped due to high peak inspiratory pressures (35%).
Conclusions:
- Manipulation of settings within the VC-SIMV mode appears more successful for achieving ventilator hyperinflations than PSV and PC-SIMV.
- VC-SIMV may be the preferred mode for optimizing airway clearance via mechanical hyperinflation in intensive care settings.
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