Di Marco F, Centanni S, Bellone A, Messinesi G, Pesci A, Scala R, Perren A, Nava S.; Crit Care. 2011 Nov 24;15(6):R283. [Epub ahead of print]
Introduction: The analysis of flow and pressure waveforms generated by ventilators can be useful in the optimization of patient-ventilator interactions, notably in chronic obstructive pulmonary disease (COPD) patients. To date, however, a real clinical benefit of this approach has not been proven.
Methods: The aim of the present randomized, multicentric, controlled study was to compare optimized ventilation, driven by the analysis of flow and pressure waveforms, to standard ventilation (same physician, same initial ventilator setting, same time spent at the bedside while the ventilator screen was obscured with numerical data always available). The primary aim was the rate of pH normalization at two hours, whilst secondary aims were changes in PaCO2, respiratory rate, and patient’s tolerance to ventilation (all parameter evaluated at baseline, 30, 120, 360 minutes and 24 hours after the beginning of ventilation). Seventy patients (35 for each group) with acute exacerbation of COPD were enrolled.
Results: Optimized ventilation lead to a more rapid normalization of pH at 2 hours (51 vs. 26% of patients), to a significant improvement of patient’s tolerance to ventilation at 2 hours, and to a higher decrease of PaCO2 at 2 and 6 hours. Optimized ventilation induced physicians to use higher levels of external positive end-expiratory pressure, more sensitive inspiratory triggers and a faster speed of pressurization.
Conclusions: The analysis of the waveforms generated by ventilators has a significant positive effect on physiological and patients’ centered outcomes during acute exacerbation of COPD. The acquisition of specific skills in this field should be encouraged.
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