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Korean J Crit Care Med > Volume 21(1); 2006 > Article
Korean Journal of Critical Care Medicine 2006;21(1): 8-16.
압력보조환기법에서 호기감수성[Expiratory Sensitivity (ESENS)]수준에 따른 호흡역학의 변화
서광원·전규락*·안종준·제갈양진·홍상범*·임채만*·고윤석*
울산대학교 의과대학 울산대학교병원 내과학교실, *서울아산병원 호흡기내과
Alteration of Lung Mechanics Depending on Expiratory Sensitivity (ESENS) during Pressure Support Ventilation
Kwang Won Seo, Gyu Rak Chon, Jong Joon Ahn, Yangjin Jega, Sang Bum Hong, Chae Man Lim, Younsuck Koh
1The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.
2Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. yskoh@amc.seoul.kr
ABSTRACT
BACKGROUND: To evaluate effects of 5 expiratory sensitivity (ESENS) levels (5%; 15%; 25%; 35%; 45%) on lung mechanics and the effects depending on the two P(0.1) levels (<3 cm H2O; > or =3 cm H2O). METHODS: Prospective, randomized, physiologic study for intubated adult patients during weaning from mechanical ventilation. Patients were randomly submitted to the 5 settings of ESENS in the Galileo ventilator (Galileo Gold, Hamilton Medical AG, Switzerland). Physiologic variables were continuously measured using a Bicore CP-100 pulmonary mechanics monitor (CP-100, Bicore, USA). RESULTS: Thirteen patients, ten men and three women, with a mean age of 65.2+/-16.1 yr were studied. Tidal volume (V(T)) decreased significantly from ESENS 5% to 45%. With increasing levels of ESENS, respiratory rates (RR) steadily increased from ESENS 5% to 35% and 45%. Shallow breath index (F/V(T)) increased significantly from ESENS 5% to 45%. Inspiratory time (T(I)) decreased gradually significantly from ESENS 5% to 45%. RR and F/V(T) increased from ESENS 5% to 15% and 45% and V(T) decreased gradually in patients with P(0.1)<3 cm H2O group, but not in patients with P(0.1)> or =3 cm H2O. CONCLUSIONS: The proper adjustment of expiratory sensitivity (ESENS) levels improved patient-ventilator synchrony and decreased respiratory rates and shallow breath index, especially in P(0.1)<3 cm H2O during PSV in ventilator weaning patients. Lower ESENS level would be more appropriate in terms of lung mechanics in patients with less than 3 cm H2O of P(0.1).
Key Words: Mechanical ventilation; Weaning; Work of breathing
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