PULMONARY GAS EXCHANGE RESPONSE TO WEANING WITH PRESSURESUPPORT VENTILATION IN EXACERBATED COPD PATIENTS

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PULMONARY GAS EXCHANGE RESPONSE TO WEANING WITH PRESSURE-SUPPORT VENTILATION IN EXACERBATED COPD PATIENTS Miquel Ferrer, MD, Raquel Iglesia, MD, Josep Roca, MD, Felip Burgos, RN, Antoni Torres, MD, Robert Rodriguez-Roisin MD. Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona,Spain.

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Successful Weaning in COPD Spontaneous Breathing vs Volume-Cycled Ventilation Rapid and shallow pattern of breathing Increased oxygen cost of breathing Increased VA/Q mismatch Increased QT and PVO2 No changes in arterial oxygenation Torres et al. Am Rev Respir Dis 1989; 140: 1246-50 Lemaire et al. Anesthesiology 1988;69:171-79 - . . .

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Aim of the Study Analysis of the intra and extrapulmonary determinants of abnormal gas exchange in COPD patients during ventilator weaning, among three conditions: Pressure Support Ventilation Volume-Cycled Ventilation Spontaneous Breathing

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Hypothesis PSV can prevent worsening of VA/Q mismatch, compared to spontaneous breathing PSV can prevent worsening of hemodynamic conditions compared to Volume-Cycled Ventilation . .

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Patients Seven COPD Patients: Age 68 ± 6 yrs, males FEV1 26 ± 6% pred Standard weaning criteria: Glasgow coma score 15 No fever No vasoactive drugs PaO2>60 mmHg at FIO2<0.4, PEEP<5 cmH2O

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Measurements Arterial and Mixed Venous Blood Gases VA/Q Distributions (Multiple Inert Gas Elimination Technique) Pulmonary and Systemic Hemodynamics Breathing Pattern and Airways Pressure .

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Protocol Pressure Support Ventilation Inspiratory pressure 10-20 cmH2O PEEP ~ 5 cmH2O Volume-Cycled Assist-Control Ventilation VT 10 mL/kg Appropriate respiratory rate Spontaneous breathing

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Breathing Pattern * * p<0.001 p<0.001

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Arterial Oxygenation

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Cardiac Output and Mixed Venous PO2 . I * * p<0.005 p<0.01

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Ventilation-Perfusion Distributions p=0.07 *

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Alveolar Ventilation . * p<0.005 * p<0.001

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Conclusion In COPD patients during weaning: PSV and ACV providing equivalent levels of ventilatory assistance result in identical physiological determinants of abnormal pulmonary gas exchange PSV avoided VA/Q worsening during the transition from positive-pressure ventilation to spontaneous breathing Increased cardiac output during spontaneous breathing prevented further worsening of arterial oxygenation during this condition

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