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The effectiveness of pressure support ventilation for mechanical ventilatory support in children
H Tokioka1, M Kinjo, M Hirakawa
1Department of Anesthesiology and Resuscitology, Okayama University Medical School, Japan.
Insights
Pressure support ventilation (PSV) effectively reduces the work of breathing in children undergoing mechanical ventilation. This study demonstrated that PSV significantly decreases respiratory effort and improves breathing patterns in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Children's rapid respiratory rates can cause patient-ventilator asynchrony and increase work of breathing during mechanical ventilation.
- Small endotracheal tubes and demand valves exacerbate work of breathing in pediatric patients.
- Pressure support ventilation (PSV) is known to reduce work of breathing in adults, but its effects in children are not well-documented.
Purpose of the Study:
- To investigate the impact of PSV on breathing patterns in children.
- To evaluate the effect of PSV on the work of breathing in pediatric patients.
Main Methods:
- Six children aged 3-5 years were studied postoperatively.
- Three levels of PSV (0, 5, 10 cmH2O) were applied.
- Measurements included airway pressure, flow, tidal volume, minute ventilation, respiratory frequency, esophageal pressure changes (delta Pes), and esophageal pressure-volume loops.
Main Results:
- Tidal volume increased and respiratory frequency decreased with increasing PSV levels.
- The work of breathing, measured by delta Pes, significantly decreased from 8.9 cmH2O (no PSV) to 2.7 cmH2O (10 cmH2O PSV).
- Mechanical work of breathing decreased from 0.743 J/L (no PSV) to 0.196 J/L (10 cmH2O PSV).
Conclusions:
- PSV effectively supports spontaneous breathing in children.
- PSV significantly reduces the work of breathing in pediatric patients requiring mechanical ventilation.
Background:
The rapid respiratory frequency of children may lead to patient-ventilator asynchrony and increase the work of breathing during mechanical ventilation, and the use of a small endotracheal tube and a demand valve can further increase this work of breathing. Although pressure support ventilation (PSV) is well known to reduce the work of breathing in adults, there are no reports regarding clinical studies of PSV in children. Therefore, the effect of PSV on breathing patterns and the work of breathing in children was studied.
Methods:
Six children (3-5 yr of age) were studied in the immediate postoperative period. Three levels of PSV, 0, 5, and 10 cmH2O, were employed. Airway pressure, flow, tidal volume, minute ventilation, and respiratory frequency were measured. To assess the work of breathing, the negative deflection of esophageal pressure (delta Pes) caused by inspiratory effort was measured. The inspiratory work of breathing was also estimated directly by measuring the esophageal pressure-volume loop using the Campbell technique.
Results:
Although minute ventilation did not change with PSV, tidal volume increased and respiratory frequency decreased with increasing levels of PSV. The delta Pes decreased markedly from 8.9 cmH2O with PSV of 0 cmH2O to 5.7 cmH2O with PSV of 5 cmH2O and 2.7 cmH2O with PSV of 10 cmH2O. The mechanical work of breathing also decreased from 0.743 Joules/l with PSV of 0 cmH2O to 0.463 Joules/l with PSV of 5 cmH2O and 0.196 Joules/l with PSV of 10 cmH2O.
Conclusions:
It was concluded that PSV can effectively augment spontaneous breathing and reduce the work of breathing in children.