Ventilator Settings Can Substantially Impact Patients' Comfort

Authors

Spyridon Fortis, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA.Follow
Jorge Florindez, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA.
Shiva Balasingham, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA.
Manuel De Aguirre, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA.Follow
Yaw Amoateng-Adjepong, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA.Follow
Constantine A. Manthous, Department of Medicine, Bridgeport Hospital, Yale University, Bridgeport, CT, USA constantinemanthous@gmail.com.Follow

Document Type

Article

Publication Title

Journal of intensive care medicine

Abstract

BACKGROUND: With increasing realization that sedatives may complicate care of mechanically ventilated patients, greater emphasis might turn to promoting comfort by titration of ventilator settings. HYPOTHESIS: Patients with acute on chronic respiratory failure (ACRF) with underlying chronic obstructive pulmonary disease (COPD) demonstrate different levels of comfort in response to varying ventilator settings compared to those with underlying obesity hypoventilation syndrome (OHS). METHODS: Patients recovering from ACRF with underlying COPD or OHS were randomized to varying combinations of ventilator modes (assist control and pressure support), tidal volumes, and inspiratory flows for 3 minutes/setting. For each ventilator setting, physiologic variables were recorded and patients indicated their level of comfort using a 10-point Borg scale. RESULTS: In all, 20 patients, aged 68 ± 13 years (standard deviation) and ventilated for 4.9 days, were enrolled. Of 20 patients, 13 had COPD and 7 had OHS. No ventilator mode, flow, or tidal volume provided consistently greater comfort between the groups, but patients reported substantial ranges of comfort (up to 8 Borg points) across the ventilator settings studied. There were no significant differences in heart rate, blood pressure, or airway pressures within patients across ventilator settings or between the groups, but patients with OHS were more tachypneic compared to patients with COPD while breathing on assist control of 6 mL/kg (constant flow 60 L/min) and 8 mL/kg (decelerating flow 40 L/min). There was no correlation between comfort and systolic blood pressure, heart rate, or respiratory rate. CONCLUSION: Ventilator parameters may impact patients' comfort substantially. Future studies may help identify evidence-based methodology for gauging comfort following changes in ventilator settings and the settings that are most likely to positively impact various groups of patients.

First Page

286

Last Page

91

DOI

10.1177/0885066613519574

Publication Date

7-1-2015

Recommended Citation

Fortis, Spyridon; Florindez, Jorge; Balasingham, Shiva; De Aguirre, Manuel; Amoateng-Adjepong, Yaw; and Manthous, Constantine A., "Ventilator Settings Can Substantially Impact Patients' Comfort" (2015). Critical Care. 29.
https://scholar.bridgeporthospital.org/critical_care/29

Identifier

24446238 (pubmed); 10.1177/0885066613519574 (doi); 0885066613519574 (pii)