PMID- 24255158
OWN - NLM
STAT- MEDLINE
DCOM- 20150708
LR  - 20151119
IS  - 1943-3654 (Electronic)
IS  - 0020-1324 (Linking)
VI  - 59
IP  - 7
DP  - 2014 Jul
TI  - Intrapulmonary percussive ventilation superimposed on conventional mechanical 
      ventilation: comparison of volume controlled and pressure controlled modes.
PG  - 1116-22
LID - 10.4187/respcare.02727 [doi]
AB  - BACKGROUND: Previous bench studies suggest that dynamic hyperinflation may occur 
      if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical 
      ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. 
      We tested the hypothesis that pressure controlled continuous mandatory 
      ventilation (PC-CMV) can protect against this risk. METHODS: An ICU ventilator 
      was connected to an IPV device cone adapter that was attached to a lung model 
      (compliance 30 mL/cm H2O, resistance 20 cm H2O/L/s). We measured inspired tidal 
      volume (VTI) and lung pressure (Plung). Measurements were first taken with IPV 
      off and the ICU ventilator set to VC-CMV or PC-CMV mode with a targeted VTI of 
      500 mL. For each mode, an inspiratory time (TI) of 0.8 or 1.5 s and PEEP 7 or 15 
      cm H2O were selected. The experiments were repeated with the IPV set to either 20 
      or 30 psi. The dependent variables were differences in VTI (DeltaVTI) and Plung with 
      IPV off or on. The effect of VC-CMV or PC-CMV mode was tested with the ICU 
      ventilators for TI, PEEP, and IPV working pressure using repeated measures of 
      analysis of variance. RESULTS: At TI 0.8 s and 20 psi, DeltaVTI was significantly 
      higher in VC-CMV than in PC-CMV. PEEP had no effect on DeltaVTI. At TI 1.5 s and 20 
      psi and at both TI values at each psi, mode and PEEP had a significant effect on 
      DeltaVTI. With the ICU ventilators at TI 1.5 s, PEEP 7 cm H2O, and 30 psi, DeltaVTI (mean 
      +/- SD) ranged from -27 +/- 25 to -176 +/- 6 mL in PC-CMV and from 258 +/- 369 to 369 +/- 
      16 mL in VC-CMV. The corresponding ranges were -15 +/- 17 to -62 +/- 68 mL in PC-CMV 
      and 26 +/- 21 to 102 +/- 95 mL in VC-CMV at TI 0.8 s, PEEP 7 cm H2O, and 20 psi. 
      Similar findings pertained to Plung. CONCLUSIONS: When IPV is added to mechanical 
      ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. 
      We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to 
      avoid autotriggering.
CI  - Copyright (c) 2014 by Daedalus Enterprises.
FAU - Riffard, Guillaume
AU  - Riffard G
AD  - Service de Reanimation Polyvalente, Hopital Nord, Centre Hospitalier 
      Universitaire de Saint-Etienne, Saint-Etienne, France.
FAU - Buzenet, Julien
AU  - Buzenet J
AD  - Hautes Etudes d'Ingenieur de Lille, Lille, France.
FAU - Guerin, Claude
AU  - Guerin C
AD  - Service de Reanimation Medicale, Groupement Hospitalier Nord, Centre Hospitalier 
      Universitaire de Lyon, Lyon, France. claude.guerin@chu-lyon.fr.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20131119
PL  - United States
TA  - Respir Care
JT  - Respiratory care
JID - 7510357
SB  - IM
MH  - Critical Care
MH  - Humans
MH  - Lung Compliance/physiology
MH  - Models, Biological
MH  - *Percussion
MH  - Positive-Pressure Respiration/adverse effects/*methods
MH  - Positive-Pressure Respiration, Intrinsic/etiology/*prevention & control
MH  - Tidal Volume/physiology
OTO - NOTNLM
OT  - bench study
OT  - hyperinflation
OT  - intrapulmonary percussive ventilation
OT  - lung model
OT  - mechanical ventilation
OT  - pressure controlled continuous mandatory ventilation
OT  - volume controlled continuous mandatory ventilation
EDAT- 2013/11/21 06:00
MHDA- 2015/07/15 06:00
CRDT- 2013/11/21 06:00
PHST- 2013/11/21 06:00 [entrez]
PHST- 2013/11/21 06:00 [pubmed]
PHST- 2015/07/15 06:00 [medline]
AID - respcare.02727 [pii]
AID - 10.4187/respcare.02727 [doi]
PST - ppublish
SO  - Respir Care. 2014 Jul;59(7):1116-22. doi: 10.4187/respcare.02727. Epub 2013 Nov 
      19.