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British Journal of Anaesthesia, 2003, Vol. 91, No. 1 106-119
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Review Article

Patient–ventilator interaction

E. Kondili, G. Prinianakis and D. Georgopoulos*

Department of Intensive Care, University Hospital, University of Crete, School of Medicine, Heraklion, Crete, Greece

Corresponding author: Intensive Care Unit, University Hospital, P.O. Box 1352, Heraklion, 71110, Crete, Greece. E-mail: georgop@med.uoc.gr

Keywords: ventilation; equipment, ventilators

The first 150 words of the full text of this article appear below.

The respiratory control system consists of a motor arm, which executes the act of breathing, a control centre in the medulla oblongata and a number of pathways that convey information to the control centre.2 69 On the basis of this information, the control centre activates spinal motor neurones serving respiratory muscles, with an intensity and rate that can vary substantially between breaths. The activity of spinal motor neurones is carried by peripheral nerves to the respiratory muscles, which contract and generate pressure (Pmus). According to the equation of motion for the respiratory system, Pmus is dissipated to overcome the resistance (Rrs) and elastance (Ers) of the respiratory system (inertia is assumed to be negligible), as follows:

Pmus=(RrsxV·)+(ErsxV)(1)

where V is volume relative to passive functional residual capacity (FRC) and V· is flow. Equation 1 determines volume in relation to time and, . . . [Full Text of this Article]

Response of the ventilator to patient effort

Ventilator-related factors
Trigger variable
Factors that alter pressure delivery
Cycling off variable
Patient-related factors
Mechanics of the respiratory system
Characteristics of the Pmus waveform
Response of patient effort to ventilator-delivered breath

Mechanical feedback
Chemical feedback
Contribution of chemical feedback to Pmus during mechanical ventilation
Effectiveness of chemical feedback during mechanical ventilation
Wakefulness
Sleep and sedation
Reflex feedback
Behavioural feedback
Composite response of Pmus to Paw
Conclusion


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