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(Chest. 1995;107:1665-1672.)
© 1995 American College of Chest Physicians

Pressure Support Ventilation Attenuates the Cardiopulmonary Response to an Acute Increase in Oxygen Demand

James Harding MD1; Marcia Kemper BA, CRTT1; and Charles Weissman MD1

1 From the Departments of Anesthesiology and Medicine, Columbia University, College of Physicians & Surgeons, New York

Critically ill patients undergo interventions, such as chest physical therapy, that acutely increase metabolic rate. Previous observations revealed that chest physical therapy is accompanied by increases of 40 to 50% in oxygen consumption (VO2) and of 40% in minute ventilation contributes to the rise in VO2 and its associated hemodynamic responses. This was done by increasing mandatory ventilatory support during the chest physical therapy session: In phase 1 the mandatory ventilation rate was increased by 35% and in phase 2 pressure support ventilation 15 cm H2O was added. In phase 1 (n=12), the increase in mandatory rate did not attenuate the chest physical therapy induced rises in heart rate, arterial blood pressure and VO2. The increase in minute ventilation when the mandatory rate was increased prevented a rise in PaCO2. In phase 2 (n=15), no change in the increase in VO2 with chest physical therapy was observed with the addition of pressure support. Yet the rises in heart rate and systemic and pulmonary artery pressures were attenuated, as was the increase in PaCO2. Respiratory rate did not increase as much with pressure support. There appears to be a role for pressure support ventilation in attenuating the pulmonary and hemodynamic responses to interventions that increase oxygen demand.

Key Words: carbon dioxide elimination • chest physical therapy • critical care • intermittent mandatory ventilation • mechanical ventilation • oxygen demand • pressure support ventilation

Submitted on June 21, 1993
Accepted on November 16, 1994




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