Skip to main content
×
Home
    • Aa
    • Aa

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

  • R. Kuhlen (a1), M. Max (a1), R. Dembinski (a1), S. Terbeck (a1), E. Jürgens (a1) and R. Rossaint (a1)...
Abstract

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.

Copyright
Corresponding author
Correspondence to: Ralf Kuhlen, Klinik für Anaesthesiologie, Medizinische Einrichtungen der RWTH Aachen, Pauwelsstrasse 30, D–52074 Aachen, Germany. E-mail: Ralf.Kuhlen@post.rwth-aachen.de; Tel: +49 241 8088179; Fax: +49 241 8888406
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

EstebanA, AliaI, GordoF, 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 Med1997; 156: 459465.

EstebanA, FrutosF, TobinMJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group.N Engl J Med1995; 332: 345350.

BrochardL, RaussA, BenitoS, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation.Am J Respir Crit Care Med1994; 150: 896903.

BerstenAD, RuttenAJ, VedigAE, SkowronskiGA. Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators.Crit Care Med1989; 17: 671684.

ShapiroM, WilsonRK, CasarG, BloomK, TeagueRB. Work of breathing through different sized endotracheal tubes.Crit Care Med1986; 14: 10281031.

FabryB, HaberthurC, ZappeD, 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 Med1997; 23: 545552.

BrochardL, RuaF, LoriniH, LemaireF, HarfA. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube.Anesthesiology1991; 75: 739745.

HaberthurC, ElsasserS, EberhardL, StockerR, GuttmannJ. Total versus tube-related additional work of breathing in ventilator-dependent patients.Acta Anaesthesiol Scand2000; 44: 749757.

StrausC, LouisB, IsabeyD, et al. Contribution of the endotracheal tube and the upper airway to breathing workload.Am J Respir Crit Care Med1998; 157: 2330.

IshaayaAM, NathanSD, BelmanMJ. Work of breathing after extubation.Chest1995; 107: 204209.

NathanSD, IshaayaAM, KoernerSK, BelmanMJ. Prediction of minimal pressure support during weaning from mechanical ventilation.Chest1993; 103: 12151219.

GuttmannJ, BernhardH, MolsG, et al. Respiratory comfort of automatic tube compensation and inspiratory pressure support in conscious humans.Intensive Care Med1997; 23: 11191124.

MolsG, RohrE, BenzingA, et al. Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects.Acta Anaesthesiol Scand2000; 44: 223230.

MolsG, Ungern-SternbergB, RohrE, HaberthurC, GeigerK, GuttmannJ. Respiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance.Crit Care Med2000; 28: 19401946.

HiggsBD, BehrakisPK, BevanDR, Milic-EmiliJ. Measurement of pleural pressure with esophageal balloon in anesthetized humans.Anesthesiology1983; 59: 340343.

KuhlenR, HausmannS, SlamaK, RossaintR, FalkeK. A new method for P0.1 measurement using standard respiratory equipment.Intensive Care Med1995; 21: 554560.

KuhlenR, RossaintR. Electronic extubation – is it worth trying?Intensive Care Med1997; 23: 11051107.

VillafaneMC, CinnellaG, LofasoF, et al. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices.Anesthesiology1996; 85: 13411349.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

European Journal of Anaesthesiology
  • ISSN: 0265-0215
  • EISSN: 1365-2346
  • URL: /core/journals/european-journal-of-anaesthesiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Abstract views

Total abstract views: 53 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd May 2017. This data will be updated every 24 hours.