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Identifier 000437481
Title Μελέτη παρατήρησης της συχνότητας εμφάνισης ταχύπνοιας μη εξαρτώμενης από το αναπνευστικό φορτίο σε βαρέως πάσχοντες ασθενείς κατά την περίοδο απογαλακτισμού τους από τον αναπνευστήρα
Alternative Title Inspiratory effort and breathing pattern change in response to varying the assist level
Author Λιλίτσης, Εμμανουήλ
Thesis advisor Κονδύλη, Ευμορφία
Reviewer Γεωργόπουλος, Δημήτριος
Παπαϊωάννου, Αλεξάνδρα
Χρυσός, Εμμανουήλ
De Bree, Eelco
Τζανάκης, Νικόλαος
Βαπορίδη, Αικατερίνη
Abstract General part Respiratory rate can be considered as a final output of o complex system. This complex system is composed from a central controller, the effectors and the sensors. The central controller (central nervous system) receives information through sensors from the periphery and then through effectors reassess and redefines the arterial blood gases. Ventilation and oxygenation physiologically are considered to be very fine and independent closed system. Yet, in pathological states, normal ventilation and oxygenation cannot be achieved without external help from mechanical ventilators which assist or even substitute normal breathing. Ideally, the level of assist should not only result in normal or near-normal arterial blood gases but also to normal or near-normal levels of inspiratory effort, to prevent both over- and under-assistance induced injury of the diaphragm. The interaction during respiration between central controller and a mechanical ventilator is considered to be extremely complex. Proportional assist ventilation is mode used to assist normal respiration with the unique advantage that the patient maintains the main control of his breath while inspiratory flow and volume are augmented according to a pre-set level. This study used a validated prototype monitor (PVI) which measures the patients’ inspiratory effort during assisted breath by calculating it from the equation of motion of respiratory system. Specific part The aim of this study is to describe the response of breathing pattern (tidal volume and respiratory rate) and inspiratory effort upon changes in assist level and to assess if changes in respiratory rate may indicate changes in respiratory muscle effort. We prospectively studied 82 patients ventilated on three different levels of proportional assist ventilation (PAV+). The patients’ inspiratory effort and breathing pattern were evaluated using a validated prototype monitor (PVI). Independent of the assist level, a wide range of respiratory rates (16–35br/min) was observed when patients’ effort was within the accepted range. Changing the assist level resulted in paired changes in inspiratory effort and rate of the same tendency (increase or decrease) in all but four patients. Increasing the level in assist resulted in a 31 % (8–44 %) decrease in inspiratory effort and a 10 % (0–18 %) decrease in respiratory rate. The change in respiratory rate upon the change in assist correlated modestly with the change in the effort (R = 0.5). Changing assist level results in changes in both respiratory rate and effort in the same direction, with change in effort being greater than that of respiratory rate. Yet, neither the magnitude of respiratory rate change nor the resulting absolute value may reliably predict the level of effort after a change in assist.
Language Greek
Issue date 2021-03-29
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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