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British Journal of Anaesthesia, 2002, Vol. 89, No. 3 373-375
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial

Editorial II

Pressure support ventilation and the critically ill patient with muscle weakness

J. W. H. Watt1

1 Spinal Injuries Unit, Southport and Ormskirk Hospital NHS Trust, Town Lane, Southport PR8 6PN, UK

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

The case reports by Kannan and colleagues1 in this issue of British Journal of Anaesthesia serve to highlight that we should remain alert for inspiratory triggering failure during pressure support ventilation (PSV) in patients with severe muscle weakness. Despite improvements in the ability of ventilators to respond to the patient’s own breathing pattern, inspiratory triggering failure may also be encountered in patients with chronic obstructive airways disease (COAD) or acute lung injury, who have high intrinsic positive end-expiratory pressure (PEEPi) in addition to possible muscle fatigue. There is also the potential for expiratory triggering failure and mismatches in tidal exchange in PSV.

Used for respiratory support and weaning, PSV has an inspiratory phase initiated by muscle effort (Pmus). The trigger—depending upon the machine and its options—is either the transient airway pressure drop below a set threshold, or the ventilator-sensed difference between the instantaneous inspiratory and expiratory flows, superimposed . . . [Full Text of this Article]


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