Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance

Authors

  • Janalee Isaacson MSN RN,

    1. Associate Professor, Nursing Program, Johnson County Community College, Kansas, USAInstructor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas, USAProfessor, Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USAAssociate Professor, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
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  • Nan Smith-Blair MSN RN,

    1. Associate Professor, Nursing Program, Johnson County Community College, Kansas, USAInstructor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas, USAProfessor, Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USAAssociate Professor, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
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  • Richard L. Clancy PhD,

    1. Associate Professor, Nursing Program, Johnson County Community College, Kansas, USAInstructor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas, USAProfessor, Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USAAssociate Professor, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
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  • Janet D. Pierce DSN ARNP CCRN

    1. Associate Professor, Nursing Program, Johnson County Community College, Kansas, USAInstructor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas, USAProfessor, Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USAAssociate Professor, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
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Janalee Isaacson, Associate Professor, Nursing Program, Johnson County Community College, 12345 College Blvd. ClB 115, Overland Park, KS 66210-1299, USA. E-mail: isaacson@jccc.net

Abstract

Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance

Many patients who are on mechanical ventilation are on ventilator modes called pressure support ventilation (PSV) and continuous positive airway pressure (CPAP) particularly when they are being weaned. As the diaphragm is responsible for approximately 75% of breathing, it is important to promote diaphragm shortening to optimize weaning from mechanical ventilation. The purpose of our 1998 quasi-experimental study was to explore the effects of PSV and CPVP on diaphragm shortening. An animal model was utilized using four Sprague–Dawley rats from the same litter purchased from Sasco (Kansas City, USA). Also measured in this study were intrathoracic pressure (ΔITP), positive inspiratory pressure, respiratory rate, tidal volume, end-tidal carbon dioxide, central venous pressure (CVP) and mean arterial pressure (MAP). Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end-tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed. These results support that higher levels CPAP may hinder diaphragmatic function thus prolong mechanical ventilation. The purpose of this pilot study was to explore the effects of PSV and CPAP on diaphragm shortening. Also measured were ΔITP, positive inspiratory pressure, respiratory rate, tidal volume, end-tidal carbon dioxide, CVP and MAP. Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end-tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed.

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