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James M. Hurst, MD; Richard D. Branson, RRT; Kenneth Davis, Jr, MD; Roger R. Barrette, MD

Arch Surg. 1989;124(9):1067-1070.

Abstract
• Pressure support ventilation (PSV) is a newer mode of ventilatory support that augments the patient's spontaneous inspirations to a preselected peak inspiratory pressure. We studied the effects of adding low levels of PSV (5 to 10 cm H₂O) in conjunction with intermittent mandatory ventilation (IMV) on 15 patients who required mechanical ventilation for flail chest and pulmonary contusion. Patients were selected for the study if, during weaning from IMV, the following criteria were met: (1) a Paco₂ level greater than 45 mm Hg, (2) a spontaneous respiratory rate (RR) greater than 30 breaths per minute, (3) a minute ventilation (VE) greater than 9.0 L/min, and (4) spontaneous tidal volumes (VT) of less than 2 mL/kg. The PSV was added to the IMV at a level that augmented spontaneous VT to greater than 4 mL/kg. An average of 9±3 cm H₂O of pressure support resulted in a fall in the level of Paco₂ (50 ± 4 to 43 ± 5 mm Hg), spontaneous RR (36±5 to 16±3 breaths per minute), VE (12±2 to 8.4±1.5 L/min), and dead space–tidal volume ratio from (0.68±0.1 to 0.47±0.05). Mean airway pressure and Pao₂ both increased, but these changes were not statistically significant. Oxygen consumption was also unchanged. These results suggest that in patients who are difficult to wean due to respiratory muscle fatigue (characterized by increasing RR and decreasing VT), PSV normalizes lung volumes, improves ventilation, and may expedite the weaning process.

(Arch Surg. 1989;124:1067-1070)

Author Affiliations
From the Division of Trauma/Critical Care, Department of Surgery, University Hospital Medical Center, University of Cincinnati (Ohio) College of Medicine.

Footnotes
Accepted for publication December 12, 1988.

Presented at the Annual Meeting of the Eastern Association for the Surgery of Trauma, Long Boat Key, Fla, January 14, 1988.

Reprint requests to University Hospital, Department of Surgery ML 558, Division of Trauma/Critical Care, 231 Bethesda Ave, Cincinnati, OH 452670558 (Dr Hurst).

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