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Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing

Rees, S. E. ; Larraza, S. ; Dey, N. ; Spadaro, S. ; Brohus, J. B. ; Winding, R. W. ; Volta, C. A. ; Karbing, D. S.

Journal of clinical monitoring and computing, 2017-08, Vol.31 (4), p.773-781 [Periódico revisado por pares]

Dordrecht: Springer Netherlands

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Título:
Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing
Autor: Rees, S. E. ; Larraza, S. ; Dey, N. ; Spadaro, S. ; Brohus, J. B. ; Winding, R. W. ; Volta, C. A. ; Karbing, D. S.
Assuntos: Anesthesiology ; Breathing ; Capnography - instrumentation ; Capnography - methods ; Carbon dioxide ; Carbon Dioxide - analysis ; Critical Care Medicine ; Data analysis ; Exhalation ; Expiration ; Health Sciences ; Humans ; Intensive ; Intensive care ; Lung - physiology ; Medicine ; Medicine & Public Health ; Original Research ; Patients ; Positive-Pressure Respiration ; Positive-Pressure Respiration, Intrinsic ; Reproducibility of Results ; Respiration ; Respiration, Artificial ; Statistics for Life Sciences ; Tidal Volume ; Time Factors ; Ventilation ; Ventilators
É parte de: Journal of clinical monitoring and computing, 2017-08, Vol.31 (4), p.773-781
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Descrição: Incomplete expiration of tidal volume can lead to dynamic hyperinflation and auto-PEEP. Methods are available for assessing these, but are not appropriate for patients with respiratory muscle activity, as occurs in pressure support. Information may exist in expiratory flow and carbon dioxide measurements, which, when taken together, may help characterize dynamic hyperinflation. This paper postulates such patterns and investigates whether these can be seen systematically in data. Two variables are proposed summarizing the number of incomplete expirations quantified as a lack of return to zero flow in expiration (IncExp), and the end tidal CO 2 variability (var et CO 2 ), over 20 breaths. Using these variables, three patterns of ventilation are postulated: (a) few incomplete expirations (IncExp < 2) and small var et CO 2 ; (b) a variable number of incomplete expirations (2 ≤ IncExp ≤ 18) and large var et CO 2 ; and (c) a large number of incomplete expirations (IncExp > 18) and small var et CO 2 . IncExp and var et CO 2 were calculated from data describing respiratory flow and CO 2 signals in 11 patients mechanically ventilated at 5 levels of pressure support. Data analysis showed that the three patterns presented systematically in the data, with periods of IncExp < 2 or IncExp > 18 having significantly lower variability in end-tidal CO 2 than periods with 2 ≤ IncExp ≤ 18 ( p < 0.05). It was also shown that sudden change in IncExp from either IncExp < 2 or IncExp > 18 to 2 ≤ IncExp ≤ 18 results in significant, rapid, change in the variability of end-tidal CO 2 p < 0.05. This study illustrates that systematic patterns of expiratory flow and end-tidal CO 2 are present in patients in supported mechanical ventilation, and that changes between these patterns can be identified. Further studies are required to see if these patterns characterize dynamic hyperinflation. If so, then their combination may provide a useful addition to understanding the patient at the bedside.
Editor: Dordrecht: Springer Netherlands
Idioma: Inglês

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Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing

Rees, S. E. ; Larraza, S. ; Dey, N. ; Spadaro, S. ; Brohus, J. B. ; Winding, R. W. ; Volta, C. A. ; Karbing, D. S.

Dordrecht: Springer Netherlands

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