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) [1].

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.

References

1. Mojoli F et al. Intensive Care Med. 2015 [Epub ahead of print]

From Springer Open Access ICMX