Patient-ventilator partitioning of the work of breathing during weaning

The work of breathing and its division between the patient and the mechanical ventilator were studied during weaning of 5 post-operative surgical patients from Synchronized Intermittent Mandatory Ventilation. Work by the patient (WP) was estimated by integrating the product of flow and pressure over time during intervals when waveforms indicated patient effort; ventilator work (WV) was similarly estimated during positive pressure inspirations. The ratio of WP to the rate of work on the lungs (WL) increased progressively during weaning from 0.14 +/- 0.04 to 1.2 +/- 0.15 while WV/WL dropped from 1.31 +/- 0.08 to 0.13 +/- 0.11. Work on the lungs decreased during weaning. This was due in part to significant improvements in lung mechanics: resistance decreased from 9.9 +/- 0.9 to 6.1 +/- 1.6 cmH2O/1/s and compliance increased from 58 +/- 17 to 102 +/- 30 ml/cmH2O. The patient and ventilator work ratios, and the work of breathing quantify factors which may be directly useful to the clinician and to future systems to automate weaning.