See the published version of this preprint at Critical Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
Research
Salvatore Grasso
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0287-0232
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: 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 hours 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.
Method: 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 hours (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5 - 15 mV), “Low” (EAdiPEAK < 5 mV) and “High” (EAdiPEAK >15 mV) neuro-ventilatory drive.
Results: 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 breaths (22 %). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0,55 hours, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than one hour, median 6.1 [3.9 - 8.5] hours and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2 – 7.8] hours. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts.
Conclusions: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 hours of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.
Keywords
mechanical ventilation, assisted modes of ventilation, pressure support ventilation (PSV)
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Critical Care.
Version 2
Posted 14 Sep, 2020
No community comments so far
Editorial decision: Accept
On 21 Oct, 2020
Reviewer #2 agreed
On 08 Oct, 2020
Review #1 received
Received 16 Sep, 2020
Reviewers invited
Invitations sent on 15 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Editor assigned
On 11 Sep, 2020
Submission checks complete
On 10 Sep, 2020
Editor invited
On 10 Sep, 2020
No comments provided
Editorial decision: Major revision
On 12 Aug, 2020
Review #2 received
Received 11 Aug, 2020
Review #1 received
Received 09 Aug, 2020
Reviewer #2 agreed
On 04 Aug, 2020
Reviewer #1 agreed
On 22 Jul, 2020
Reviewers invited
Invitations sent on 21 Jul, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
First submitted
On 13 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Critical Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Salvatore Grasso
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0287-0232
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Critical Care.
Version 2
Posted 14 Sep, 2020
No community comments so far
Editorial decision: Accept
On 21 Oct, 2020
Reviewer #2 agreed
On 08 Oct, 2020
Review #1 received
Received 16 Sep, 2020
Reviewers invited
Invitations sent on 15 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Editor assigned
On 11 Sep, 2020
Submission checks complete
On 10 Sep, 2020
Editor invited
On 10 Sep, 2020
No comments provided
Editorial decision: Major revision
On 12 Aug, 2020
Review #2 received
Received 11 Aug, 2020
Review #1 received
Received 09 Aug, 2020
Reviewer #2 agreed
On 04 Aug, 2020
Reviewer #1 agreed
On 22 Jul, 2020
Reviewers invited
Invitations sent on 21 Jul, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
First submitted
On 13 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Critical Care.
Introduction: 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 hours 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.
Method: 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 hours (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5 - 15 mV), “Low” (EAdiPEAK < 5 mV) and “High” (EAdiPEAK >15 mV) neuro-ventilatory drive.
Results: 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 breaths (22 %). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0,55 hours, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than one hour, median 6.1 [3.9 - 8.5] hours and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2 – 7.8] hours. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts.
Conclusions: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 hours of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Loading...