Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients.

Critical Care : the Official Journal of the Critical Care Forum
Rosa DI MussiSalvatore Grasso

Abstract

Pressure support ventilation (PSV) should allow spontaneous breathing with a "normal" neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of "Low" and/or "High" neuro-ventilatory drive during clinical application of PSV. In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdiPEAK), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTPDI/b and PTPDI/min, respectively), breathing pattern and major asynchronies were continuously monitored for 12 h (from 8 a.m. to 8 p.m.). We identified breaths with "Normal" (EAdiPEAK 5-15 μV), "Low" (EAdiPEAK < 5 μV) and "High" (EAdiPEAK > 15 μV) neuro-ventilatory drive. Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdiPEAK, was "Low" in 50.116 breath (28%), "Normal" in 88.419 breaths (50%) and "High" in 38.582 br...Continue Reading

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Citations

Jun 9, 2021·Critical Care : the Official Journal of the Critical Care Forum·Filippo AlbaniGiuseppe Natalini

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Methods Mentioned

BETA
Sedation

Software Mentioned

Kleistek
Servo i
NAVA tracker
EAdi
SAS
ICU Lab

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