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Research ArticleOriginal Research

Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation

Chun-Hsiang Yu, Po-Lan Su, Wei-Chieh Lin, Sheng-Hsiang Lin and Chang-Wen Chen
Respiratory Care February 2015, 60 (2) 201-209; DOI: https://doi.org/10.4187/respcare.03408
Chun-Hsiang Yu
Division of Chest Medicine
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Po-Lan Su
Division of Chest Medicine
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Wei-Chieh Lin
Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan.
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Sheng-Hsiang Lin
Institute of Clinical Medicine
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Chang-Wen Chen
Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan.
Medical Device Innovation Center, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
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Abstract

BACKGROUND: Late inspiratory rise in airway pressure (LIRAP, Paw/ΔT) caused by inspiratory muscle relaxation or expiratory muscle contraction is frequently seen during pressure support ventilation (PSV), although the modulating factors are unknown.

METHODS: We investigated the effects of respiratory mechanics (normal, obstructive, restrictive, or mixed), inspiratory effort (−2, −8, or −15 cm H2O), flow cycle criteria (5–40% peak inspiratory flow), and duration of inspiratory muscle relaxation (0.18–0.3 s) on LIRAP during PSV using a lung simulator and 4 types of ventilators.

RESULTS: LIRAP occurred with all lung models when inspiratory effort was medium to high and duration of inspiratory muscle relaxation was short. The normal lung model was associated with the fastest LIRAP, whereas the obstructive lung model was associated with the slowest. Unless lung mechanics were normal or mixed, LIRAP was unlikely to occur when inspiratory effort was low. Different ventilators were also associated with differences in LIRAP speed. Except for within the restrictive lung model, changes in flow cycle level did not abolish LIRAP if inspiratory effort was medium to high. Increased duration of inspiratory relaxation also led to the elimination of LIRAP. Simulation of expiratory muscle contraction revealed that LIRAP occurred only when expiratory muscle contraction occurred sometime after the beginning of inspiration.

CONCLUSIONS: Our simulation study reveals that both respiratory resistance and compliance may affect LIRAP. Except for under restrictive lung conditions, LIRAP is unlikely to be abolished by simply lowering flow cycle criteria when inspiratory effort is strong and relaxation time is rapid. LIRAP may be caused by expiratory muscle contraction when it occurs during inspiration.

  • patient-ventilator asynchrony
  • pressure support ventilation
  • late inspiratory rise in airway pressure

Footnotes

  • Correspondence: Chang-Wen Chen MD MSc, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan. E-mail: cwchen{at}mail.ncku.edu.tw.
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The study was supported by grant NCKUH-10202047 from the National Cheng Kung University Hospital, Tainan City, Taiwan. The authors have disclosed no conflicts of interest.

  • Copyright © 2015 by Daedalus Enterprises
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Respiratory Care: 60 (2)
Respiratory Care
Vol. 60, Issue 2
1 Feb 2015
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Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation
Chun-Hsiang Yu, Po-Lan Su, Wei-Chieh Lin, Sheng-Hsiang Lin, Chang-Wen Chen
Respiratory Care Feb 2015, 60 (2) 201-209; DOI: 10.4187/respcare.03408

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Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation
Chun-Hsiang Yu, Po-Lan Su, Wei-Chieh Lin, Sheng-Hsiang Lin, Chang-Wen Chen
Respiratory Care Feb 2015, 60 (2) 201-209; DOI: 10.4187/respcare.03408
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Keywords

  • patient-ventilator asynchrony
  • pressure support ventilation
  • late inspiratory rise in airway pressure

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