Use of Pressure Muscle Index to Avoid Over-assistance During Pressure Support Ventilation

Use of Pressure Muscle Index to Avoid Over-assistance During Pressure Support Ventilation

Pressure support ventilation (PSV) is the most commonly used mode in mechanical ventilated patients. Studies have shown that over-assistance was prevalent in patients undergoing PSV. Up to now, no reliable method has been recommended to select an "optimal" inspiratory support level. Pressure muscle index (PMI) was introduced recently to evaluate the degree of spontaneous breathing effort. We hypothesize that PMI might be used as an indicator for over-assistance during PSV. In this randomized crossover study, inspiratory support is set at three levels according to negative, positive and zero PMI. Inspiratory effort, work of breathing, and respiratory mechanics are compared among the three inspiratory pressure support levels.

Inclusion Criteria:

• Mechanical ventilated patients within 48 hours after the transition from a controlled mode to PSV

Exclusion Criteria:

• History of neuromuscular disease
• History of diaphragm dysfunction and surgery
• History of esophageal, gastric or lung surgery
• Decreased level of consciousness
• Central respiratory drive dysfunction
• Considered withholding of life support