The measurement of respiratory mechanics with new dynamic approach during noninvasive bi-level positive pressure ventilation: a bench study_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 CHEN Yuqing ¹ , YUAN Yueyang ² , ZHANG Hai ¹ , LI Feng ¹ , ZHOU Xin ³

1. Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China;
2. School of Mechanical and Electrical Engineering, Hunan City University, Yiyang, Hunan 413049, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, P. R. China;

Corresponding author：

CHEN Yuqing, Email: chenyqn69@163.com

Keywords：

Pressure support ventilation; Respiratory mechanics; Dynamic; Noninvasive ventilation; Chronic obstructive pulmonary disease

DOI：

10.7507/1671-6205.201901070

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Objective To evaluate the accuracy of the new dynamic approach in the measurement of respiratory mechanics with different pressure support (PS) level during pressure support ventilation (PSV) via oral-nasal mask.Methods The Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in patients with chronic obstructive pulmonary disease ［system compliance (C_rs)=50 mL/cm H₂O, airway resistance (R_aw)=20 cm H₂O/(L·s), inspiratory time (T_I)=1.6 s, breathing rate=15 beats per minute］. PSV were applied with different levels of PS ［positive end-expiratory pressure=5 cm H₂O, PS=5/10/15/20/25 cm H₂O) and back-up rate=10 beats per minute］. Measurements were conducted at system leaks with 25 – 28 L/min. The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time and workload. C_rs and R_aw were calculated by using new dynamic approach.Results Tidal volume (V_T) was increased with increasing PS level ［(281.45±4.26)mL at PS 5 cm H₂O vs. (456.81±1.91)mL at PS 10 cm H₂O vs. (747.45±3.22)mL at PS 20 cm H₂O, P<0.01］. Severe asynchronous was occurred frequently when PS is at 25 cm H₂O. Inspiration cycling criterion (CC) was up-regulated accompanied by increasing PS level ［(15.62±3.11)% at 5 cm H₂O, vs. (24.50±0.77)% at 20 cm H₂O, P<0.01］. Premature cycling was always existed during PSV when PS < 20 cm H₂O, which could be eliminated as PS level increasing. Delay cycling was found when PS was at 20 cm H₂O, and cycling delay time was (33.60±15.91)ms (P<0.01). The measurement of C_rs was (46.19±1.57)mL/cm H₂O with PS at 10 cm H₂O, which was closer to the preset values of simulated lung. The underestimate of C_rs was observed during high level PS support. The calculation of inspiratory and expiratory resistance was approximate to 20 cm H₂O/(L·s) when PS level was exceeded 15 cm H₂O.Conclusions The new dynamic approach can continuously assess the respiratory mechanics during non-invasive ventilation, which is no need to interrupt the patient's spontaneous breathing. Higher inspiratory flow during PSV is beneficial for R_aw measurement, whereas the accuracy of C_rs was influenced by the value of actual V_T.

Citation： CHEN Yuqing, YUAN Yueyang, ZHANG Hai, LI Feng, ZHOU Xin. The measurement of respiratory mechanics with new dynamic approach during noninvasive bi-level positive pressure ventilation: a bench study. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(6): 537-542. doi: 10.7507/1671-6205.201901070 Copy

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2.	Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med, 2016, 42(10): 1567-1575.
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9.	Beloncle F, Akoumianaki E, Rittayamai N, et al. Accuracy of delivered airway pressure and work of breathing estimation during proportional assist ventilation: a bench study. Ann Intensive Care, 2016, 6(1): 30.
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11.	Macintosh BR, Peterson CV Jr, Otis AB. Effective resistance of the respiratory system studied by a quick release technique. Respir Physiol, 1985, 60(3): 329-346.
12.	于莲芝, 颜国正, 李蛟, 等. 内置直接呼吸监测系统的气道阻力分析. 仪器仪表学报, 2006, 27(6增): 1444-1445.
13.	Karamolegkos N, Albanese A, Isaza F, et al. Patient emulator: a tool for testing mechanical ventilation therapies. Conf Proc IEEE Eng Med Biol Soc, 2016, 2016: 4321-4324.
14.	罗祖金, 詹庆元, 米玉红. 新一代比例辅助通气模式在慢性阻塞性肺疾病急性加重患者中的生理学研究. 中国呼吸与危重监护杂志, 2014, 13(6): 550-555.
15.	陈志远, 吴健华, 王玉珍, 等. 低潮气量联合呼气末正压通气对慢性阻塞性肺疾病患者腹腔镜手术时肺功能的影响. 中华麻醉学杂志, 2013, 33(10): 1229-1232.
16.	牛艳霞, 程青虹, 王雯, 等. 不同氧流量驱动肝素雾化吸入对慢性阻塞性肺疾病急性加重期机械通气患者呼吸力学的影响. 中国急救医学, 2014, 34(8): 703-707.
17.	Volta CA, Marangoni E, Alvisi V, et al. Respiratory mechanics by least squares fitting in mechanically ventilated patients: application on flow-limited COPD patients. Intensive Care Med, 2002, 28(1): 48-52.
18.	Iotti GA, Braschi A, Brunner JX, et al. Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med, 1995, 21(5): 406-413.
19.	Khirani S, Polese G, Aliverti A, et al. On-line monitoring of lung mechanics during spontaneous breathing: a physiological study. Respir Med, 2010, 104(3): 463-471.
20.	Nassar BS, Collett ND, Schmidt GA. The flow-time waveform predicts respiratory system resistance and compliance. J Crit Care, 2012, 27(4): 418.
21.	Avanzolini G, Barbini P, Cappello A, et al. Influence of flow pattern on the parameter estimates of a simple breathingmechanics model. IEEE Trans Biomed Eng, 1995, 42(4): 394-402.
22.	Vasconcelos Rdos S, Melo LH, Sales RP, et al. Effect of an automatic triggering and cycling system on comfort and patient-ventilator synchrony during pressure support ventilation. Respiration, 2013, 86(6): 497-503.
23.	Carteaux G, Lyazidi A, Cordoba-Izquierdo A, et al. Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study. Chest, 2012, 142(2): 367-376.
24.	Chen Y, Cheng K, Zhou X. Effectiveness of inspiratory termination synchrony with automatic cycling during noninvasive pressure support ventilation. Med Sci Monit, 2016, 22: 1694-1701.

1. Gattinoni L, Marini JJ, Collino F, et al. The future of mechanical ventilation: lessons from the present and the past. Crit Care, 2017, 21(1): 183.
2. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med, 2016, 42(10): 1567-1575.
3. Chiumello D, Carlesso E, Brioni M, et al. Airway driving pressure and lung stress in ARDS patients. Crit Care, 2016, 20: 276.
4. 陈宇清, 周新. 急性呼吸窘迫综合征的压力–容积曲线及其临床应用. 中国呼吸与危重监护杂志, 2007, 6(4): 314-317, 320.
5. 中华医学会呼吸病学分会呼吸生理与重症监护学组, 《中华结核和呼吸杂志》编辑委员会. 无创正压通气临床应用专家共识. 中华结核和呼吸杂志, 2009, 32(2): 86-98.
6. Akashiba T, Ishikawa Y, Ishihara H, et al. The Japanese Respiratory Society Noninvasive Positive Pressure Ventilation (NPPV) Guidelines (second revised edition). Respir Investig, 2017, 55(1): 83-92.
7. Lichtwarck-Aschoff M, Kessler V, Sjöstrand UH, et al. Static versus dynamic respiratory mechanics for setting the ventilator. Br J Anaesth, 2000, 85(4): 577-586.
8. Guttmann J. Analysis of respiratory mechanics during artificial ventilation. Biomed Tech (Berl), 1998, 43(4): 107-115.
9. Beloncle F, Akoumianaki E, Rittayamai N, et al. Accuracy of delivered airway pressure and work of breathing estimation during proportional assist ventilation: a bench study. Ann Intensive Care, 2016, 6(1): 30.
10. Bates JH, Schmalisch G, Filbrun D, et al. Tidal breath analysis for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Eur Respir J, 2000, 16(6): 1180-1192.
11. Macintosh BR, Peterson CV Jr, Otis AB. Effective resistance of the respiratory system studied by a quick release technique. Respir Physiol, 1985, 60(3): 329-346.
12. 于莲芝, 颜国正, 李蛟, 等. 内置直接呼吸监测系统的气道阻力分析. 仪器仪表学报, 2006, 27(6增): 1444-1445.
13. Karamolegkos N, Albanese A, Isaza F, et al. Patient emulator: a tool for testing mechanical ventilation therapies. Conf Proc IEEE Eng Med Biol Soc, 2016, 2016: 4321-4324.
14. 罗祖金, 詹庆元, 米玉红. 新一代比例辅助通气模式在慢性阻塞性肺疾病急性加重患者中的生理学研究. 中国呼吸与危重监护杂志, 2014, 13(6): 550-555.
15. 陈志远, 吴健华, 王玉珍, 等. 低潮气量联合呼气末正压通气对慢性阻塞性肺疾病患者腹腔镜手术时肺功能的影响. 中华麻醉学杂志, 2013, 33(10): 1229-1232.
16. 牛艳霞, 程青虹, 王雯, 等. 不同氧流量驱动肝素雾化吸入对慢性阻塞性肺疾病急性加重期机械通气患者呼吸力学的影响. 中国急救医学, 2014, 34(8): 703-707.
17. Volta CA, Marangoni E, Alvisi V, et al. Respiratory mechanics by least squares fitting in mechanically ventilated patients: application on flow-limited COPD patients. Intensive Care Med, 2002, 28(1): 48-52.
18. Iotti GA, Braschi A, Brunner JX, et al. Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med, 1995, 21(5): 406-413.
19. Khirani S, Polese G, Aliverti A, et al. On-line monitoring of lung mechanics during spontaneous breathing: a physiological study. Respir Med, 2010, 104(3): 463-471.
20. Nassar BS, Collett ND, Schmidt GA. The flow-time waveform predicts respiratory system resistance and compliance. J Crit Care, 2012, 27(4): 418.
21. Avanzolini G, Barbini P, Cappello A, et al. Influence of flow pattern on the parameter estimates of a simple breathingmechanics model. IEEE Trans Biomed Eng, 1995, 42(4): 394-402.
22. Vasconcelos Rdos S, Melo LH, Sales RP, et al. Effect of an automatic triggering and cycling system on comfort and patient-ventilator synchrony during pressure support ventilation. Respiration, 2013, 86(6): 497-503.
23. Carteaux G, Lyazidi A, Cordoba-Izquierdo A, et al. Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study. Chest, 2012, 142(2): 367-376.
24. Chen Y, Cheng K, Zhou X. Effectiveness of inspiratory termination synchrony with automatic cycling during noninvasive pressure support ventilation. Med Sci Monit, 2016, 22: 1694-1701.

Chinese Journal of Respiratory and Critical Care Medicine

The measurement of respiratory mechanics with new dynamic approach during noninvasive bi-level positive pressure ventilation: a bench study

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