Correlation Between Volume Dependence of Respiratory Mechanics and Dynamic Intrinsic Positive End-Expiratory Pressure in COPD Patients During Pressure Support Ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUANG He ¹ , SHI Rui ¹ , XUN Xihui ¹ , LI Yinhuan ² , LIU Xiaoqing ² , CHEN Rongchang. ²

First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital. Shenzhen, Guangdong,518035, ChinaCorresponding Author: HUANG He, E-mail: hehuang0822@ 163. com;

Corresponding author：

Keywords：

Chronic obstructive pulmonary disease; Pressure support ventilation; Respiratory mechanics; Nonlinearity; Dynamic intrinsic positive end-expiratory pressure

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Objective To investigate the correlation between dynamic intrinsic positive endexpiratory pressure ( PEEPidyn) and volume dependence of elastance and resistance of respiratory system ( Evd/Rvd) derived from nonlinear analysis of respiratory mechanics in COPD patients during pressure support ventilation ( PSV) . Methods Twenty-five COPD patients mechanically ventilated using mode of PSV were ventilated at a PSV level of no less than 20 cm H2O in a period of 15 minutes to attain so-called
near-relaxation state. The pressure( P) , flow( V′) and volume( V) data were analyzed by nonlinear mode of respiratory motion. PEEPidyn was determined by esophageal balloon-tipped catheter technique. The correlations between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were analyzed. Results The correlation coefficients between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were 0. 85,0. 80, and 0. 90, respectively. Conclusions Nonlinear mode of respiratory motion is suitable to analyze respiratory mechanics of COPD patients mechanically ventilated using mode of PSV. There are good correlations between PEEPidyn and Evd,Rvd as well as Evd ×Rvd which may be used to noninvasively monitor PEEPidyn in mechanically ventilated COPD patients using mode of PSV.

Citation： HUANG He,SHI Rui,XUN Xihui,LI Yinhuan,LIU Xiaoqing,CHEN Rongchang.. Correlation Between Volume Dependence of Respiratory Mechanics and Dynamic Intrinsic Positive End-Expiratory Pressure in COPD Patients During Pressure Support Ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 557-559. doi: Copy

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2.	Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J, 2005, 25 : 186-199.
3.	刘晓青, 黄河, 李寅环, 等. COPD 患者机械通气呼吸力学容积依赖性系数与内源性呼气末正压的相关性分析. 现代临床医学生物工程学杂志, 2007, 13: 25 -28 .
4.	刘晓青, 黄河, 李寅环, 等. COPD 患者压力支持通气时呼吸力学线性和非线性分析拟合效率的比较. 广州医学院学报, 2007 ,35: 19 -21 .
5.	秦朝辉, 陈荣昌, 钟南山. 慢性阻塞性肺疾病患者辅助机械通气时呼气末正压水平对呼气末肺容量的影响. 中国呼吸与危重监护杂志, 2007, 6: 23-26.
6.	Poggi R, Polese G, Morandini GC, et al. COPD patients and mechanical ventilation with positive end expiratory pressure ( PEEP) .Monaldi Arch Chest Dis, 1994, 49( 3 Suppl 1) : 40-42 .
7.	秦朝辉, 陈荣昌, 钟南山. 慢性阻塞性肺疾病内源性呼气末正压的生理学效应及临床对策. 中国呼吸与危重监护杂志, 2004, 3 :126-128.
8.	Appendini L, Confalonieri M, Rossi A. Clinical relevance of monitoring respiratory mechanics in the ventilator-supported patient:an update ( 1995-2000 ) . Curr Opin Crit Care, 2001, 7 : 41- 48.
9.	Vassiliou M, Saunier C, Duvivier C. Volume dependence of respiratory system resistance during artificial ventilation in rabbits.Intensive Care Med, 2001, 27 : 898-904.
10.	Karason S, Sondergaard S, Lundin S, et al. A new method for noninvasive,manoeuvre-free determination of “static ”pressure-volume curves during dynamic / therapeutic mechanical ventilation. Acta Anaesthesiol Scand, 2000, 44 : 578-585.
11.	Wagers S, Lundblad L, Moriya HT, et al. Nonlinearity of respiratory mechanics during bronchoconstriction in mice with airway inflammation. J Appl Physiol, 2002, 92: 1802-1807.
12.	Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J, 2005, 25 : 186-199.
13.	Iotti GA, Braschi A, Brunner JX. Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med, 1995, 21: 406-413.

1. Vassiliou MP, Amygdalou A, Psarakis CJ, et al. Volume and flow dependence of respiratory mechanics in mechanically ventilated COPD patients. Respir Physiol Neurobiol, 2003, 15 , 135: 87-96.
2. Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J, 2005, 25 : 186-199.
3. 刘晓青, 黄河, 李寅环, 等. COPD 患者机械通气呼吸力学容积依赖性系数与内源性呼气末正压的相关性分析. 现代临床医学生物工程学杂志, 2007, 13: 25 -28 .
4. 刘晓青, 黄河, 李寅环, 等. COPD 患者压力支持通气时呼吸力学线性和非线性分析拟合效率的比较. 广州医学院学报, 2007 ,35: 19 -21 .
5. 秦朝辉, 陈荣昌, 钟南山. 慢性阻塞性肺疾病患者辅助机械通气时呼气末正压水平对呼气末肺容量的影响. 中国呼吸与危重监护杂志, 2007, 6: 23-26.
6. Poggi R, Polese G, Morandini GC, et al. COPD patients and mechanical ventilation with positive end expiratory pressure ( PEEP) .Monaldi Arch Chest Dis, 1994, 49( 3 Suppl 1) : 40-42 .
7. 秦朝辉, 陈荣昌, 钟南山. 慢性阻塞性肺疾病内源性呼气末正压的生理学效应及临床对策. 中国呼吸与危重监护杂志, 2004, 3 :126-128.
8. Appendini L, Confalonieri M, Rossi A. Clinical relevance of monitoring respiratory mechanics in the ventilator-supported patient:an update ( 1995-2000 ) . Curr Opin Crit Care, 2001, 7 : 41- 48.
9. Vassiliou M, Saunier C, Duvivier C. Volume dependence of respiratory system resistance during artificial ventilation in rabbits.Intensive Care Med, 2001, 27 : 898-904.
10. Karason S, Sondergaard S, Lundin S, et al. A new method for noninvasive,manoeuvre-free determination of “static ”pressure-volume curves during dynamic / therapeutic mechanical ventilation. Acta Anaesthesiol Scand, 2000, 44 : 578-585.
11. Wagers S, Lundblad L, Moriya HT, et al. Nonlinearity of respiratory mechanics during bronchoconstriction in mice with airway inflammation. J Appl Physiol, 2002, 92: 1802-1807.
12. Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J, 2005, 25 : 186-199.
13. Iotti GA, Braschi A, Brunner JX. Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med, 1995, 21: 406-413.

Chinese Journal of Respiratory and Critical Care Medicine

Correlation Between Volume Dependence of Respiratory Mechanics and Dynamic Intrinsic Positive End-Expiratory Pressure in COPD Patients During Pressure Support Ventilation

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