Mojoli F, Orlando A, Bianchi I, Torriglia F, Bianzina S, Pozzi M, Iotti GA, Braschi A, PLUS Working Group
Intensive Care Medicine Experimental 2016, 4(Suppl 1):27;595
Introduction: Standard waveforms displayed on the ventilator screen
may help detecting whether the ventilator is switching form inspiration
to expiration at the right time, thus allowing appropriate setting
of expiratory trigger sensitivity (ETS) .
Objectives: To test reliability and effectiveness of cycling-off guided
by automated real-time waveforms analysis (IntelliSync+) available
on G5 ventilator (Hamilton Medical, CH).
Methods: In 6 patients under PSV, IntelliSync + was compared to
standard cycling-off with both default setting (ETS = 25 % of peak inspiratory
flow) and optimized setting guided by bedside waveforms
analysis of patient-ventilator interaction (PVI). Two levels of pressure
support were tested: clinically set level (PS basal) and 50 % increase
(PS + 50). ETS optimized at PS basal (ETS opti1) was selected as initial
value at PS + 50 and then if necessary re-optimized (ETS opti2). Inspiratory
trigger sensitivity was set at 2 l/min throughout the study.
Results: PS basal and PS + 50 were 12 ± 2 and 18 ± 3 cmH2O. ETS
opti1 and ETS opti2 were 36 ± 8 (range 25–50) and 51 ± 13 %
(range 35–70). Early cycling was not observed. Compared to
default setting, ETS opti1 decreased cycling delay and unassisted
efforts at PS basal, but these favorable effects were not maintained
at PS + 50. Further optimization (ETS opti2) decreased cycling
and trigger delay but did not affect unassisted efforts. When
IntelliSync + was activated, cycling delay was shorter and values
of trigger delay and unassisted efforts were at least as low as
with optimized settings of ETS. Table 100 summarizes the results
obtained in the 6 conditions tested.
Conclusions: Bedside optimization of ETS guided by waveforms on the
ventilator screen improved PVI. Increase of pressure support level worsened
PVI and mandated re-optimization of ETS. IntelliSync + performed better
than default setting of ETS and at least as good as optimized setting.
1. Mojoli F et al. Intensive Care Med. 2015 [Epub ahead of print]