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Increased spatial distribution of airflow in lungs with low-level pressure support ventilation compared with maintenance ventilation
Critical Care volume 10, Article number: P33 (2006)
Vibration response imaging (VRI) is a novel technology that utilizes sophisticated software and surface skin sensors placed on the back to record, analyze and display vibrations as a non-invasive measure of lung ventilation.
Compared with assist volume control ventilation (AVC), pressure support ventilation (PSV) will result in a greater spatial distribution of lung airflow.
We performed serial VRI during maintenance AVC and immediately following initiation of a spontaneous breathing trial using low-level PSV in 26 mechanically ventilated patients. Recordings were performed over 12–20 s periods of respiration. Respiratory cycles free of noise or motion artifacts were chosen for analysis, and images at mid-inspiration were analyzed. Areas of images were calculated digitally using the program ImageJ. The areas of right and left lung measured at mid-inspiration were summed, and compared, AVC vs PSV. Statistical analysis was performed using a t test and the t distribution.
The tidal volume (VT) was 534.8 ± 69.4 ml for AVC and decreased to 407.6 ± 152.1 ml for PSV (P = 0.00015). The mean areas of both lungs were 68.75 ± 11.06 and 71.57 ± 10.50 (mean in kilopixels ± SD) in the AVC and PSV images, respectively (P = 0.00985). There was a mean increase of 4.73 ± 9.09% in the areas of the lungs during PSV compared with AVC (P = 0.039).
Despite a lower VT, PSV (compared with ACV) produced a greater spatial distribution of lung airflow. Possible mechanisms of this PSV-associated increase are the increase in patient-generated negative intrapleural pressure during inspiration and better synchronization of patient-negative pressure with positive pressure from the ventilator. VRI allows a non-invasive quantitation of airflow distribution during different modes of mechanical ventilation.
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Jean, S., Dellinger, R., Cinel, I. et al. Increased spatial distribution of airflow in lungs with low-level pressure support ventilation compared with maintenance ventilation. Crit Care 10, P33 (2006). https://doi.org/10.1186/cc4380
- Pressure Support Ventilation
- Lung Ventilation
- Spontaneous Breathing Trial
- Skin Sensor
- Program ImageJ