Can proportional ventilation modes facilitate exercise in critically ill patients? A physiological cross-over study

被引:0
作者
Akoumianaki, Evangelia [1 ]
Dousse, Nicolas [2 ]
Lyazidi, Aissam [3 ]
Lefebvre, Jean-Claude [4 ]
Graf, Severine [2 ]
Cordioli, Ricardo Luiz [5 ]
Rey, Nathalie [6 ]
Richard, Jean-Christophe Marie [7 ,8 ]
Brochard, Laurent [9 ,10 ]
机构
[1] Univ Hosp Heraklion, Intens Care Unit, Iraklion, Crete, Greece
[2] Geneva Univ Hosp, Div Intens Care, Geneva, Switzerland
[3] Univ Hassan 1er, Lab Rayonnement Mat & Instrumentat, Inst Super Sci Sante, Settat, Morocco
[4] Univ Laval, Dept Anesthesiol & Crit Care, Quebec City, PQ, Canada
[5] Hosp Israelita Albert Einstein, Dept Adult Intens Care Unit, Sao Paulo, Brazil
[6] Rouen Univ Hosp, Dept Anesthesia & Intens Care Unit, Rouen, France
[7] Gen Hosp Annecy, Emergency Dept, Annecy, France
[8] INSERM, UMR 955, Creteil, France
[9] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
[10] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
关键词
Critically ill patients; Exercise; Assisted mechanical ventilation; Proportional ventilation; Oxygen consumption; Work efficiency; INTENSIVE-CARE-UNIT; PRESSURE-SUPPORT VENTILATION; ACUTE RESPIRATORY-FAILURE; OBSTRUCTIVE PULMONARY-DISEASE; ADJUSTABLE GAIN FACTORS; PROLONGED BED REST; LEG BLOOD-FLOW; MECHANICAL VENTILATION; ASSIST VENTILATION; MUSCLE WORK;
D O I
10.1186/s13613-017-0289-y
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Early exercise of critically ill patients may have beneficial effects on muscle strength, mass and systemic inflammation. During pressure support ventilation (PSV), a mismatch between demand and assist could increase work of breathing and limit exercise. A better exercise tolerance is possible with a proportional mode of ventilation (Proportional Assist Ventilation, PAV+ and Neurally Adjusted Ventilatory Assist, NAVA). We examined whether, in critically ill patients, PSV and proportional ventilation have different effects on respiratory muscles unloading and work efficiency during exercise. Methods: Prospective pilot randomized cross-over study performed in a medico-surgical ICU. Patients requiring mechanical ventilation >48 h were enrolled. At initiation, the patients underwent an incremental workload test on a cycloergometer to determine the maximum level capacity. The next day, 2 15-min exercise, at 60% of the maximum capacity, were performed while patients were randomly ventilated with PSV and PAV+ or NAVA. The change in oxygen consumption (Delta VO2, indirect calorimetry) and the work efficiency (ratio of Delta VO2 per mean power) were computed. Results: Ten patients were examined, 6 ventilated with PSV/PAV+ and 4 with PSV/NAVA. Despite the same mean inspiratory pressure at baseline between the modes, baseline VO2 (median, IQR) was higher during proportional ventilation (301 ml/min, 270-342) compared to PSV (249 ml/min, 206-353). Exercise with PSV was associated with a significant increase in VO2 (Delta VO2, median, IQR) (77.6 ml/min, 59.9-96.5), while VO2 did not significantly change during exercise with proportional modes (46.3 ml/min, 5.7-63.7, p < 0.05). As a result, exercise with proportional modes was associated with a better work efficiency than with PSV. The ventilator modes did not affect patient's dyspnea, limb fatigue, distance, hemodynamics and breathing pattern. Conclusions: Proportional ventilation during exercise results in higher work efficiency and less increase in VO2 compared to ventilation with PSV. These preliminary findings suggest that proportional ventilation could enhance the training effect and facilitate rehabilitation.
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页数:10
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