Neural versus pneumatic
control of pressure support in patients with chronic obstructive pulmonary
diseases at different levels of positive end expiratory pressure: a
physiological study
Critical Care 2015, 19:244 doi:10.1186/s13054-015-0971-0
Ling Liu et al
Intrinsic positive end-expiratory
pressure (PEEPi) is a “threshold” load that must be overcome to trigger
conventional pneumatically-controlled pressure support (PSP) in chronic
obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe)
reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm
electrical activity (EAdi), neurally controlled pressure support (PSN) could
hypothetically eliminate asynchrony and reduce mechanical inspiratory effort,
hence substituting the need for PEEPe. The primary objective of this study was
to show that PSN can reduce the need for PEEPe to improve patient-ventilator
interaction and to reduce both the “pre-trigger” and “total inspiratory” neural
and mechanical efforts in COPD patients with PEEPi. A secondary objective was
to evaluate the impact of applying PSN on breathing pattern.
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