Pressure support (PS) is a commonly used mode of ventilation which is triggered based upon the patient's own inspiratory efforts. For the most part, pressure support is well tolerated by patients. However, because the trigger for pressure support is an inspiratory effort by the patient, and because the resulting support is constant, the ventilator response can be "out of sync" with the patient's needs. The problem of patient-ventilator asynchrony has been documented to be large in approximately one quarter of patients who require mechanical ventilation. Asynchrony is associated with increased or abnormal work of breathing (WOB) and prolonged duration of mechanical ventilation. Diagnosing asynchrony at the bedside can be challenging. Electrical activation of the diaphragm (Eadi) recording can provide clinicians with a more accurate picture of patient-ventilator synchrony and may thus result in decreased asynchrony and decreased or normalized work of breathing for the patient. The purpose of this physiologic study is to evaluate the role of protocolized pressure support ventilation (based upon Eadi) in comparison to standard pressure support ventilation.
Pressure support will be readjusted according to Eadi recording in different steps. The optimized pressure support will be compared to the initial pressure support.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
St Michael's Hospital
Toronto, Ontario, Canada
Synchrony and patient effort determined from pressure time product measured from the esophageal pressure
Time frame: For each step of the protocol (10 minutes/step)
WOB determinated from esophageal pressure measurement using the Campbell diagram
Time frame: For each step of the protocol (10 minutes/step)
Number of asynchronies
Time frame: For each step of the protocol (10 minutes/step)
Comfort score (verbal scale)
Time frame: For each step of the protocol (10 minutes/step)
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