Effect of imposed inflation time on respiratory frequency and hyperinflation in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med. 2001 May;163(6):1365-70. doi: 10.1164/ajrccm.163.6.2001123.

Abstract

Decreases in ventilator inflation time (TI,vent) can cause tachypnea, probably as a response to lung inflation. The response may differ in chronic obstructive pulmonary disease (COPD) because time-constant inhomogeneities could foster overdistention of some lung units during early inflation, causing neural inspiratory time to be shorter than in healthy subjects. We tested the hypothesis that a decrease in TI,vent causes tachypnea, prolongation of exhalation, and a decrease in intrinsic positive end-expiratory pressure (PEEP(i)). Ten patients with stable COPD received assist-control ventilation through a mouthpiece. Decreases in TI,vent, achieved through increases in flow from 30 to 90 L/min, increased frequency, from 16.1 +/- 1.0 (SE) to 20.8 +/- 1.5 breaths/min (p < 0.001), time for exhalation, from 2.1 +/- 0.2 to 2.3 +/- 0.2 s (p < 0.025), and decreased PEEP(i), from 7.0 +/- 1.3 to 6.4 +/- 1.1 cm H(2)O (p < 0.01). Decreases in TI,vent, achieved by decreasing inspiratory pause from 2 to 0 s, increased frequency, from 12.9 +/- 0.8 to 18.1 +/- 1.6 breaths/min (p < 0.001), time for exhalation, from 2.0 +/- 0.2 to 2.6 +/- 0.3 s (p < 0.001), and decreased PEEP(i), from 6.4 +/- 1.1 to 5.5 +/- 0.9 cm H(2)O (p < 0.01). In both experiments, decreases in TI,vent reduced inspiratory effort (p < 0.01). In conclusion, strategies to reduce TI,vent in patients with COPD caused tachypnea, yet prolonged the time for exhalation with consequent decrease in PEEP(i).

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Airway Resistance
  • Blood Gas Analysis
  • Forced Expiratory Volume
  • Functional Residual Capacity
  • Humans
  • Lung Diseases, Obstructive / classification
  • Lung Diseases, Obstructive / complications
  • Lung Diseases, Obstructive / metabolism
  • Lung Diseases, Obstructive / physiopathology*
  • Lung Diseases, Obstructive / therapy*
  • Male
  • Positive-Pressure Respiration, Intrinsic / etiology*
  • Respiration, Artificial / adverse effects*
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / methods*
  • Respiratory Mechanics*
  • Severity of Illness Index
  • Signal Processing, Computer-Assisted
  • Tidal Volume
  • Time Factors