TY - JOUR
T1 - Tidal volume maintenance during weaning with pressure support
AU - Stroetz, Randolph W.
AU - Hubmayr, Rolf D.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1995/9
Y1 - 1995/9
N2 - Ventilation was measured in 31 difficult-to-wean patients while pressure support (PS) was reduced by S cm H2O every 20 min. Weaning had to be aborted in 14 of 31 patients (Group F) because they met predefined distress criteria. The remaining 17 patients who were able to complete the 'weaning test' (Group S) had larger static respiratory compliances (C(stat) = 0.08 ± 0.02 versus 0.05 ± 0.01 L/cm H2O p ≤ 0.05) and a lower dead space to tidal volume ratio (0.55 ± 0.05 versus 0.64 ± 0.06, p ≤ 0.05). Group S patients had a larger tidal volume (VT) than did those of Group F at most PS settings. The groups differed with respect to VT maintenance during PS withdrawal (p < 0.01). In Group S, VT fell exponentially with machine support and stabilized at PS levels between 5 and 10 cm H2O. In contrast, Group F patients defended VT at higher PS settings but were unable to maintain VT during distress. Ventilatory response parameters such as the rapid shallow breathing index were of limited value in predicting weaning outcome and yielded receiver operator curve area values between 0.66 and 0.82 over the range of PS settings tested. We conclude that the gradual withdrawal of machine support does not facilitate the recognition of impending respiratory failure.
AB - Ventilation was measured in 31 difficult-to-wean patients while pressure support (PS) was reduced by S cm H2O every 20 min. Weaning had to be aborted in 14 of 31 patients (Group F) because they met predefined distress criteria. The remaining 17 patients who were able to complete the 'weaning test' (Group S) had larger static respiratory compliances (C(stat) = 0.08 ± 0.02 versus 0.05 ± 0.01 L/cm H2O p ≤ 0.05) and a lower dead space to tidal volume ratio (0.55 ± 0.05 versus 0.64 ± 0.06, p ≤ 0.05). Group S patients had a larger tidal volume (VT) than did those of Group F at most PS settings. The groups differed with respect to VT maintenance during PS withdrawal (p < 0.01). In Group S, VT fell exponentially with machine support and stabilized at PS levels between 5 and 10 cm H2O. In contrast, Group F patients defended VT at higher PS settings but were unable to maintain VT during distress. Ventilatory response parameters such as the rapid shallow breathing index were of limited value in predicting weaning outcome and yielded receiver operator curve area values between 0.66 and 0.82 over the range of PS settings tested. We conclude that the gradual withdrawal of machine support does not facilitate the recognition of impending respiratory failure.
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U2 - 10.1164/ajrccm.152.3.7663780
DO - 10.1164/ajrccm.152.3.7663780
M3 - Article
C2 - 7663780
AN - SCOPUS:0029080406
SN - 1073-449X
VL - 152
SP - 1034
EP - 1040
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -