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Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients
Egyptian Journal of Bronchology volume 9, pages 198–210 (2015)
Abstract
Background
The effects of flow triggering (FT) compared with pressure triggering (PT) on breathing effort have been the focus of several studies, and discrepant results have been reported; yet, it remains an area of conflict that warrants further studies.
Objective
The aim of this work is to compare flow versus PT in ventilating patients with acute respiratory failure.
Patients and methods
One hundred patients with acute respiratory failure of pulmonary origin were assigned randomly to two groups: 50 patients ventilated with PT and 50 patients ventilated with FT. The primary end points were weaning duration, evaluation of patient/machine synchronization, total duration of ventilation and ICU stay as well time under sedation and occurrence of complications. Mortality was considered the secondary end point. Patients were categorized into those with obstructive, restrictive, and combined pulmonary disease according to their medical history, and clinical and radiological assessment, and also more and less severe disease according to the APACHE II score level (cut-off point).
Results
In all the patients studied, including those with restrictive pulmonary disorder and more severe disease (APACHE II score ≥32.5), there was a statistically significantly shorter duration of weaning, duration of ventilation, and duration of ICU stay in the FT group than the PT group. The pre-extubation oxygenation index was highly statistically significantly better in the FT group than the PT group (P < 0.001). In patients with obstructive pulmonary disorders, combined pulmonary disorders, and less severe disease (APACHE II <32.5), there was no significant difference between both PT and FT groups in these parameters.
Conclusion
FT may be considered to be better than PT in ventilating acute respiratory failure patients with a restrictive pattern and those with higher severity scoring. In obstructive and mixed ventilatory impairment, use of either of them does not make a difference.
References
Grippi MA. Respiratory failure: an overview. In: Fishman JA, Grippi MA, Kaiser LR, Senior RM, (editors) Fishman’s pulmonary diseases and disorders. 3rd ed. The McGraw-Hill Companies Inc.; 1998. 165:2525–2535.
Kim HJ, Ingbar DH. Acute respiratory failure. In: Parsons PE, Heffner JE(editors) Pulmonary/respiratory therapy secrets. 3rd ed. Elsevier Inc.; 2006. 62:459–468.
Hudson LD. Acute respiratory failure overview (Ch. 140). In: Fishman AP, (editor) Pulmonary disease and disorders. 2nd ed. Mc Graw-Hill Book Company; 1988:2189–2198.
Mador MJ, Tobin MJ. Acute respiratory failure (Ch. 19). In: Carverly, PMA, Pride NB, (editors) Chronic obstructive pulmonary disease. 1st ed. Chapman & Hall; 1995:461–494.
Sherman C, Hudson LD. Complications of acute respiratory failure. In: Bone RC, George RB, Hudson LD, editors Acute respiratory failure. New York: Churchill Livingstone; 1987. 317–334.
Bonten MJ, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clin Infect Dis 2004; 38:1141–1149.
Auriant I, Jallot A, Hervé P, Cerrina J, Le Roy Ladurie F, Fournier JL, et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 2001; 164:1231–1235.
Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163:540–577.
Tobin MJ. Mechanical ventilation. N Engl J Med 1994; 330:1056–1061.
Moxam J. Treatment by physical means: ventilation, physiotherapy and rehabilitation. In: Brewis RAL, Corrin B, Geddes DM, Gibson GJ, (editors) Respiratory medicine. 2nd ed. W B Saunders Company 1995; 13:447–467.
Tobin MJ. Respiratory monitoring. JAMA 1991; 1:34.
Marini JJ, Smith TC, Lamb VJ. External work output and force generation during synchronized intermittent mechanical ventilation. Effect of machine assistance on breathing effort. Am Rev Respir Dis 1988; 138:1169–1179.
Sassoon CS, Gruer SE. Characteristics of the ventilator pressure- and flow-trigger variables. Intensive Care Med 1995; 21:159–168.
Kondili E, Prinianakis G, Georgopoulos D. Patient-ventilator interaction. Br J Anaesth 2003; 91:106–119.
Susan P, Cairo JM. The Trigger variable. In Mechanical ventilation physiological and clinical applications. 4th ed. Philadelphia: Elsevier; 2006. 50–60.
Branson RD. Flow triggering systems. Respir Care 1994; 39:892–896.
Polese G, Massara A, Poggi R, Brandolese R, Brandi G, Rossi A. Flow-triggering reduces inspiratory effort during weaning from mechanical ventilation. Intensive Care Med 1995; 21:682–686.
Macnee W. Respiratory failure. In: Seaton A, Seaton D, Leitch AG, (editors) Crofton and Douglas’s respiratory diseases. 5th ed. 2000; 24:696–717.
Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999; 27:1325–1329.
Corrado A, Ginanni R, Villella G, Gorini M, Augustynen A, Tozzi D, et al. Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD. Eur Respir J 2004; 23:419–424.
Goulet R, Hess D, Kacmarek RM. Pressure vs flow triggering during pressure support ventilation. Chest 1997; 111:1649–1653.
Sassoon CS, Giron AE, Ely EA, Light RW. Inspiratory work of breathing on flow-by and demand-flow continuous positive airway pressure. Crit Care Med 1989; 17:1108–1114.
Giuliani R, Mascia L, Recchia F, Caracciolo A, Fiore T, Ranieri VM. Patient-ventilator interaction during synchronized intermittent mandatory ventilation. Effects of flow triggering. Am J Respir Crit Care Med 1995; 151:1–9.
Correa TD, Passos RH, Kanda S, Taniguchi C. Flow or pressure triggering during pressure support ventilation? Critical Care 2007; 11:P65.
Tantucci C, Duguet A, Giampiccolo P, Similowski T, Zelter M, Derenne JP. The best peak expiratory flow is flow-limited and effort-independent in normal subjects. Am J Respir Crit Care Med 2002; 165:1304–1308.
Branson RD, Campbell RS, Davis K Jr, Johnson DJ II. Comparison of pressure and flow triggering systems during continuous positive airway pressure. Chest 1994; 106:540–544.
Ranieri VM, Mascia L, Petruzzelli V, Bruno F, Brienza A, Giuliani R. Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med 1995; 21:896–903.
Nava S, Ambrosino N, Bruschi C, Confalonieri M, Rampulla C. Physiological effects of flow and pressure triggering during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease. Thorax 1997; 52:249–254.
Forte DN, Ranzani OT, Stape N, Taniguchi LU, Toledo-Maciel A, Park M. APACHE II and SOFA scores for intensive care and hospital outcome prediction in oncologic patients. Critical Care 2007; 11:93.
Sassoon CS, Del Rosario N, Fei R, Rheeman CH, Gruer SE, Mahutte CK. Influence of pressure- and flow-triggered synchronous intermittent mandatory ventilation on inspiratory muscle work. Crit Care Med 1994; 22:1933–1941.
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Khalil, M.M., Elfattah, N.M., El-Shafey, M.M. et al. Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients. Egypt J Bronchol 9, 198–210 (2015). https://doi.org/10.4103/1687-8426.158103
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DOI: https://doi.org/10.4103/1687-8426.158103