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Vol. 37. Issue 1.
Pages 7-13 (January 2001)
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Vol. 37. Issue 1.
Pages 7-13 (January 2001)
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Parámetros de adaptación en ventilación mecánica no invasiva. Estudio comparativo experimental
Non-invasive ventilation: an experimental study comparing parameters of adaptation
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J.D. García Jiméneza,*, J. Sánchez Segoviab, M. Herrera Carranzac, J.A. Maldonado Péreza, M. Castillo Quinteroc, R. Ayerbe Garcíaa
a Sección de Neumología. Servicios de Medicina Interna Hospital Juan Ramón Jiménez. Huelva
b Electromedicina Hospital Juan Ramón Jiménez. Huelva
c Unidad de Cuidados Intensivos. Servicio de Cuidados Críticos y Urgencias. Hospital Juan Ramón Jiménez. Huelva
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Objetivo

Evaluar experimentalmente la respuesta del trigger , de la presurización y del ciclado ante un modelo de pulmón normal, obstructivo y restrictivo de 6 equipos de ventilación mecánica no invasiva: Ventil + (VP), Respironics STD20 (RR), Puritan Bennett 335 (PB), Quantum (QT), DP90 (DP) y Sullivan II ST (SV).

Método

Se utilizó un simulador pulmonar cuyas señales analógicas de volumen, presión y flujo eran registradas en un polígrafo Mingograph 34. Los datos se obtenían con una presión inspiratoria positiva (IPAP) de 12 cmH2O, una fre-cuencia respiratoria de 17 ciclos/min, una presión espirato-ria final (EPAP) de 4 cmH2O y un esfuerzo inspiratorio equivalente a una P 0,1 de 4 cmH2O. Se calculó la presión ne-gativa de disparo, el retardo del mismo en la onda de flujo o tiempo de trigger y el flujo inspiratorio pico (FIpico) en el que se producía el cambio a espiración o punto de ciclado.

Resultados

Los equipos con mejor sensibilidad de trig-ger fueron RR y PB que demostraron una presión de disparo inferior a −1 cmH2O y un tiempo de trigger menor de 100 ms, mientras que la peor respuesta se halló en VP. El ciclado más acorde con el estándar (5–25% del FIpico) se obtuvo con el respirador RR, mientras que en los demás ventilado-res el paso a espiración se producía con flujo cero (DP90 en todos los patrones, y en PB y VP en los patrones restrictivos) o superior al 50% (en el caso de QT en todos los patrones). El análisis de las curvas de presión demostró diferencias im-portantes en la pendiente, meseta y despresurización.

Conclusiones

El comportamiento más homogéneo en las variables de fases estudiadas, que son las que más influyen en la adaptación del paciente al ventilador, se evidenció en RR.

Palabras clave:
Ventilación mecánica no invasiva
Presión positiva en vía aérea a dos niveles (BIPAP)
Interacción paciente-ventilador
Objective

To evaluate response to pressure and flow trig-gering in an experimental model of the normal, obstructive and restrictive lung with six non-invasive mechanical ventilation units: Vintil+ (VP), Respironics STD20 (RR), Puritan Bennet 335 (PB), Quantum (QT), DP90 (DP) and Sullivan II ST (SV).

Method

Analog signals of volume, pressure and flow from a lung simulator were recorded by a Mingograph 34 polygraph. Positive inspiratory pressure (PIP) was 12 cmH2O, respiratory rate was 17 cycles/min, end expiratory pressure (PEEP) was 4 cmH2O, and inspiratory effort (P 0.1 ) was 4 cmH2O. Parameters calculated were negative trigger pressure, trigger time (or the flow wave delay in triggering), and the percentage of peak inspiratory flow at which a change to exhalation or cycle phase.

Results

The RR and PB units had the best trigger res-ponse with pressure triggering below −1 cmH2O and trigger times less than 100 ms. VP proved to have the poorest res-ponse. The cycle of the RR agreed most closely with the standard (5-25% of peak inspiratory flow), whereas change to exhalation occurred with the other units with zero flow (in all patterns with DP90, and in restrictive patterns with PB and VP) or greater than 50% of peak inspiratory flow (in all models with QT). Analysis of pressure curves showed great differences in slope, plateau and depressurization.

Conclusions

The RR unit proved to have the most ho-mogeneous behavior for all the phase parameters studied as being the ones that most influence a patient's adaptation to a ventilator.

Keywords:
Non-invasive mechanical ventilation
Bi-level positi-ve airway pressure (BiPAP)
Patient-ventilator interaction
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Copyright © 2001. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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