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In vitro assessment of the effect of proportional assist ventilation on the work of breathing

Research output: Contribution to journalArticle

Olie Chowdhury, Prashanth Bhat, Gerrard F. Rafferty, Simon Hannam, Anthony D. Milner, Anne Greenough

Original languageEnglish
Pages (from-to)639-643
JournalEuropean Journal of Pediatrics
Volume175
Issue number5
Early online date8 Jan 2016
DOIs
Accepted/In press19 Nov 2015
E-pub ahead of print8 Jan 2016
PublishedMay 2016

King's Authors

Abstract

During proportional assist ventilation, elastic and resistive unloading can be delivered to reduce the work of breathing (WOB). Our aim was to determine the effects of different levels of elastic and resistive unloading on the WOB in lung models designed to mimic certain neonatal respiratory disorders. Two dynamic lung models were used, one with a compliance of 0.4 ml/cm H2O to mimic an infant with respiratory distress syndrome and one with a resistance of 300 cm H2O/l/s to mimic an infant with bronchopulmonary dypslasia. Pressure volume curves were constructed at each unloading level. Elastic unloading in the low compliance model was highly effective in reducing the WOB measured in the lung model; the effective compliance increased from 0.4 ml/cm H2O at baseline to 4.1 ml/cm H2O at maximum possible elastic unloading (2.0 cm H2O/ml). Maximum possible resistive unloading (200 cm H2O/l/s) in the high-resistance model only reduced the effective resistance from 300 to 204 cm H2O/l/s. At maximum resistive unloading, oscillations appeared in the airway pressure waveform.
Conclusion: Our results suggest that elastic unloading will be helpful in respiratory conditions characterised by a low compliance, but resistive unloading as currently delivered is unlikely to be of major clinical benefit.

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