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The appropriate setting of the ventilator in mechanically ventilated patients is of paramount importance to manage, and to avoid further significant increase of, lung hyperinflation.
◆ The setting of the ventilator during noninvasive pressure support ventilation for COPD patients is often intricate, since the altered respiratory mechanics, together with the presence of airleaks, may deeply interfere with the synchrony between the machine and the patient.
Intravenous administration of β-agonists (epinephrine, salbutamol) is also an option in extreme situations and should be considered in the treatment of patients who have not responded to inhaled or subcutaneous treatment, and in whom respiratory arrest is imminent, or in patients not adequately ventilated and severely hyperinflated, despite optimal setting of the ventilator.
When the aspiration flow rate was changed, the tidal volume setting of the ventilator was modified accordingly in order to achieve a constant minute ventilation and stable NO concentration.
Conclusions: The waveforms method is a reliable, accurate and reproducible method to assess patient-ventilator interaction and could help optimal setting of the ventilator.
Two different modes of controlled setting of the ventilator are widely used.
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Circuit compression volume is that part of VT set on the ventilator that remains within the ventilator and inspiratory circuit, and does not reach the airways of the patient.
Most of the studies involved in this demonstration measured Pplat 0.5 sec after onset of end-inspiratory pause according to the ARMA trial (2) and used PEEP set on the ventilator (PEEPvent) instead of the PEEPtot.
It is difficult to estimate the daily consumption of a patient because of heterogeneity in the conditions of use (spontaneous or mechanical ventilation), ventilator settings (in the setting of mechanical ventilation) and duration of use.
Several studies have evaluated the impact of increasing PSV levels versus NAVA levels using similar methods of setting the ventilator [ 20- 25, 25].
It was suggested that bedside analysis of ventilator waveforms may help detecting different types of asynchrony and setting properly the ventilator [1].
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