Combining PSV with other Ventilatory Modes

One of the advantages of PSV is the possibility, implemented in most new ventilators, of combining PSV with other ventilatory modes. It is surprising that, despite scanty supporting evidence, PSV in combination with SIMV is one of the most used ventilatory strategies in ICU [3].

The use of periodical recruitment maneuvers (sigh) proved effective during CPPV [49,50] to promote alveolar recruitment and improve gas exchange in ARDS

Fig. 4. Oxygen arterial tension (PaO2), and inspiratory occlusion pressure in first 100 ms (P0.1) during PSV alone (BASE1) (white bars), PSV with addition of one sigh per minute (SIGH) (gray bars), and return to PSV alone (PSV2) (white bars). * p<0.01 SIGH vs BASE1; § p<0.05 SIGH vs BASE1. Modified from [51].

Fig. 4. Oxygen arterial tension (PaO2), and inspiratory occlusion pressure in first 100 ms (P0.1) during PSV alone (BASE1) (white bars), PSV with addition of one sigh per minute (SIGH) (gray bars), and return to PSV alone (PSV2) (white bars). * p<0.01 SIGH vs BASE1; § p<0.05 SIGH vs BASE1. Modified from [51].

patients. In order to improve the efficacy of PSV and to extend its application in ARDS patients, Patroniti at al. [51] tested the use of sigh in 13 ARDS patients undergoing PSV. All patients were studied within 5 days from the diagnosis of ARDS, and none of them received CPPV before the study. Patroniti et al. combined PSV with APRV/BiPAP and delivered the sigh by applying the higher CPAP level of APRV/BiPAP ventilation at pressure higher than 35 cmH2O for at least 3 seconds once per minute. Use of sigh produced an increase in PaO2 (Fig. 4), lung volumes and Crs. Moreoverthe introduction ofsigh resulted in a decreased respiratory drive as indicated by the significant reduction in P0.1 (Fig. 4). The authors concluded that the association of PSV and sigh could extend the use of PSV itself and that the introduction of sigh may enhance feasibility and tolerability of partial ventilatory techniques in ALI/ARDS patients.

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