Title: Manipulation ofventilator settings topreventactive expiration against positive pressureinflation
Abstract: SUMMARY Recentpublications havesuggested thatininfants receiving artificial ventilatory support aparticular pattern ofinteraction between spontaneous breaths andventilator inflations (active expiration against eachventilator inflation) may beimportant intheproduction of pneumothoraces. We havelooked atpatterns ofinteraction from47preterminfants studied on 51occasions. We foundthatactive expiration against theventilator occurred on a total of16 occasions. Thispattern was prevented on 14occasions byaltering theventilator settings. Intwo otherbabies, thepatternpersisted butneither babydeveloped a pneumothorax. Recently, Greenough etalldescribed various patterns ofbreathing theyhaveobserved ininfants of less than34weeks' gestation whowerereceiving artificial ventilation. Theyrelated onespecific patternofbreathing, occurring during artificial ventilation, withthedevelopment ofpneumothorax.2 Thispattern theydescribe as'Active expiratory effort against eachventilator inflation'.' During thepast15months wehavedeveloped a system thatallows ustooptimise theventilatory support given tooursickest preterm infants. Todo this we havebeenrecording ventilator inflation pressure, oesophageal pressure, tidal volume, and transcutaneous oxygen tension (TcPo2) andcarbon dioxide tension (TcPco2) during aseries ofchanges inventilator settings. Inthecourse ofourstudies we havebecomeawareofthedeleterious effect that theinfants' ownrespiratory efforts canhaveonthe applied ventilation. We alsoobserved thatthe infants' ownpattern ofrespiration could often be modified bychanging theventilator settings. We decided todetermine howoften active expiration against theventilator occurred andhowoften we couldabolish thispattern bychanges inventilator settings. Classification Greenough etall described five patterns ofinteraction:
Publication Year: 1985
Publication Date: 1985-01-01
Language: en
Type: article
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