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Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients

Published online by Cambridge University Press:  02 June 2005

R. Kuhlen ,
M. Max ,
R. Dembinski ,
S. Terbeck ,
E. Jürgens  and
R. Rossaint
R. Kuhlen
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
M. Max
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
R. Dembinski
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
S. Terbeck
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
E. Jürgens
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
R. Rossaint
Affiliation:
University of Aachen Medical School, Department of Anesthesiology, Aachen, Germany
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Extract

Summary

Background and objective: Automatic tube compensation has been designed as a new ventilatory mode to compensate for the non-linear resistance of the endotracheal tube. The study investigated the effects of automatic tube compensation compared with breathing through a T-piece or pressure support during a trial of spontaneous breathing used for weaning patients from mechanical ventilation of the lungs.

Methods: Twelve patients were studied who were ready for weaning after prolonged mechanical ventilation (10.2 ± 8.4 days) due to acute respiratory failure. Patients with chronic obstructive pulmonary disease were excluded. Thirty minutes of automatic tube compensation were compared with 30 min periods of 7 cmH2O pressure support and T-piece breathing. Breathing patterns and workload indices were measured at the end of each study period.

Results: During T-piece breathing, the peak inspiratory flow rate (0.65 ± 0.20 L s−1) and minute ventilation (8.9 ± 2.7 L min−1) were lower than during either pressure support (peak inspiratory flow rate 0.81 ± 0.25 L s−1; minute ventilation 10.2 ± 2.3 L min−1, respectively) or automatic tube compensation (peak inspiratory flow rate 0.75 ± 0.26 L s−1; minute ventilation 10.8 ± 2.7 L min−1). The pressure–time product as well as patients' work of breathing were comparable during automatic tube compensation (pressure–time product 214.5 ± 104.6 cmH2O s−1 min−1, patient work of breathing 1.1 ± 0.4 J L−1) and T-piece breathing (pressure–time product 208.3 ± 121.6 cmH2O s−1 min−1, patient work of breathing 1.1 ± 0.4 J L−1), whereas pressure support resulted in a significant decrease in workload indices (pressure–time product 121.2 ± 64.1 cmH2O s−1 min−1, patient work of breathing 0.7 ± 0.4 J L−1).

Conclusions: In weaning from mechanical lung ventilation, patients' work of breathing during spontaneous breathing trials is clearly reduced by the application of pressure support 7 cmH2O, whereas the workload during automatic tube compensation corresponded closely to the values during trials of breathing through a T-piece.

Keywords

RESPIRATION, ARTIFICIAL, ventilator weaningRESPIRATION, respiratory mechanics, pulmonary ventilationRESPIRATORY DISORDERS, respiratory insufficiency
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 1 , January 2003 , pp. 10 - 16
Copyright
© 2003 European Society of Anaesthesiology

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References

Esteban A, Alia I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997; 156: 459–465.Google Scholar
Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995; 332: 345–350.Google Scholar
Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994; 150: 896–903.Google Scholar
Bersten AD, Rutten AJ, Vedig AE, Skowronski GA. Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators. Crit Care Med 1989; 17: 671–684.Google Scholar
Bersten AD, Rutten AJ, Vedig AE. Efficacy of pressure support in compensating for apparatus work. Anaesth Intens Care 1993; 21: 67–71.Google Scholar
Shapiro M, Wilson RK, Casar G, Bloom K, Teague RB. Work of breathing through different sized endotracheal tubes. Crit Care Med 1986; 14: 1028–1031.Google Scholar
Haberthur C, Fabry B, Stocker R, Ritz R, Guttmann J. Additional inspiratory work of breathing imposed by tracheostomy tubes and non-ideal ventilator properties in critically ill patients. Intensive Care Med 1999; 25: 514–519.Google Scholar
Fabry B, Haberthur C, Zappe D, et al. Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation. Intensive Care Med 1997; 23: 545–552.Google Scholar
Guttmann J, Eberhard L, Fabry B, Bertschmann W, Wolff G. Continuous calculation of intratracheal pressure in tracheally intubated patients. Anesthesiology 1993; 73: 503–513.Google Scholar
Brochard L, Rua F, Lorini H, Lemaire F, Harf A. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 1991; 75: 739–745.Google Scholar
Fabry B, Guttmann J, Eberhard L, Wolff G. Automatic compensation of endotracheal tube resistance in spontaneously breathing patients. Technol Health Care 1994; 1: 281–291.Google Scholar
Kuhlen R, Guttmann J, Nibbe L, et al. Proportional pressure support and automatic tube compensation: new options for assisted spontaneous breathing. Acta Anaesthesiol Scand 1997; 111 (Suppl): 155–159.Google Scholar
Haberthur C, Elsasser S, Eberhard L, Stocker R, Guttmann J. Total versus tube-related additional work of breathing in ventilator-dependent patients. Acta Anaesthesiol Scand 2000; 44: 749–757.Google Scholar
Straus C, Louis B, Isabey D, et al. Contribution of the endotracheal tube and the upper airway to breathing workload. Am J Respir Crit Care Med 1998; 157: 23–30.Google Scholar
Ishaaya AM, Nathan SD, Belman MJ. Work of breathing after extubation. Chest 1995; 107: 204–209.Google Scholar
Nathan SD, Ishaaya AM, Koerner SK, Belman MJ. Prediction of minimal pressure support during weaning from mechanical ventilation. Chest 1993; 103: 1215–1219.Google Scholar
Guttmann J, Bernhard H, Mols G, et al. Respiratory comfort of automatic tube compensation and inspiratory pressure support in conscious humans. Intensive Care Med 1997; 23: 1119–1124.Google Scholar
Mols G, Rohr E, Benzing A, et al. Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects. Acta Anaesthesiol Scand 2000; 44: 223–230.Google Scholar
Mols G, Ungern-Sternberg B, Rohr E, Haberthur C, Geiger K, Guttmann J. Respiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance. Crit Care Med 2000; 28: 1940–1946.Google Scholar
Higgs BD, Behrakis PK, Bevan DR, Milic-Emili J. Measurement of pleural pressure with esophageal balloon in anesthetized humans. Anesthesiology 1983; 59: 340–343.Google Scholar
Kuhlen R, Hausmann S, Slama K, Rossaint R, Falke K. A new method for P0.1 measurement using standard respiratory equipment. Intensive Care Med 1995; 21: 554–560.Google Scholar
Kuhlen R, Rossaint R. Electronic extubation – is it worth trying? Intensive Care Med 1997; 23: 1105–1107.Google Scholar
Villafane MC, Cinnella G, Lofaso F, et al. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 1996; 85: 1341–1349.Google Scholar