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Effect of varying the pressurisation rate during noninvasive pressure support ventilation

¹ Intensive Care Unit Heraklion Hospital, Crete, Greece and ² Respiratory Intensive Care Unit, Fondazione S. Maugeri, Istituto Ricovero e Cura Carattere Scientifico, Istituto Scientifico di Pavia, Pavia, Italy

CORRESPONDENCE: S. Nava, Respiratory Unit, Fondazione S. Maugeri, Via Ferrata 8, 27100 Pavia, Italia. Fax: 39 0382592075. E-mail: snava@fsm.it

Keywords: chronic obstructive pulmonary disease, initial inspiratory flow, noninvasive pressure support ventilation, ventilator settings

Received: January 29, 2003
Accepted September 10, 2003

The aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients' breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage.

A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate.

No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients' tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate.

In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance.

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