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VOLUME 25 , ISSUE 9 ( September, 2021 ) > List of Articles

Original Article

Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units

Pooneh Barati, Somayeh Ghafari, Mahmood Saghaei

Keywords : Intensive care unit, Mechanical ventilation, Pressure support, Respiratory distress

Citation Information : Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021; 25 (9):1026-1030.

DOI: 10.5005/jp-journals-10071-23960

License: CC BY-NC 4.0

Published Online: 08-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Incorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases the patient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI) method can reduce patients’ respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods. Patients and methods: The study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients’ respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressure support was then adjusted in the patients according to the RSBI (in the trial group, n = 33) and VT and RR (in the control group, n = 23). The patients’ respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment. Results: The results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272). Conclusion: These two methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods. Key message: VT, RR, and RSBI methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods.

  1. Criner G. Long-term ventilator-dependent patients: new facilities and new models of care: the American perspective. Rev Port Pneumol 2012;18(5):214–216. DOI: 10.1016/j.rppneu.2012.04.004.
  2. Youssef HAA, Shalaby AEO, Abd El Hafiz AM, Shaban MM, Hamed HA. Predictive value of rapid shallow breathing index in relation to the weaning outcome in ICU patients. Egypt J Chest Dis Tuberc 2016;65(2):465–472. DOI: 10.1016/S0929-6646(09)60135-2.
  3. Urden LD, Stacy KM, Lough ME. Critical care nursing-e-book: diagnosis and management. Elsevier Health Sciences; 2017.
  4. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006;32(10):1515–1522. DOI: 10.1007/s00134-006-0301-8.
  5. Campbell ML, Templin TN. Intensity cut-points for the respiratory distress observation scale. Palliat Med 2015;29(5):436–442. DOI: 10.1177/0269216314564238.
  6. Ambrosino N, Vitacca M. The patient needing prolonged mechanical ventilation: a narrative review. Multidiscip Respir Med 2018;13. DOI: 10.1186/s40248-018-0118-7.
  7. Elliott S, Morrell-Scott N. Care of patients undergoing weaning from mechanical ventilation in critical care. Nurs Stand 2017;32(13):41–51. DOI: 10.7748/ns.2017.e10854.
  8. Desai JP, Moustarah F. Pulmonary compliance. StatPearls [Internet]. StatPearls Publishing; 2019.
  9. Alberti A, Gallo F, Fongaro A, Valenti S, Rossi A. P0.1 is a useful parameter in setting the level of pressure support ventilation. Intensive Care Med 1995;21(7):547–553. DOI: 10.1007/BF01700158.
  10. Perrigault PF, Pouzeratte YH, Jaber S, Capdevila XJ, Hayot M, Boccara G, et al. Changes in occlusion pressure (P0.1) and breathing pattern during pressure support ventilation. Thorax 1999;54(2):119– 123. DOI: 10.1136/thx.54.2.119.
  11. Vincent J-L, Abraham E, Kochanek P, Moore FA, Fink MP. Textbook of critical care e-book. Elsevier Health Sciences; 2016.
  12. Morton PG, Fontaine DK, Hudak C, Gallo B. Critical care nursing: a holistic approach. Lippincott Williams & Wilkins Philadelphia; 2005.
  13. Elliott D, Aitken L, Chaboyer W. Critical care nursing. Sydney: Mosby Elsevier; 2007. p. 448–453.
  14. Marino PL. The ICU book. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. 1059 p.
  15. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332(6):345–350. DOI: 10.1056/NEJM199502093320601.
  16. Cairo JM. Pilbeam's mechanical ventilation. St. Louis, Missouri: Elsevier; 2016.
  17. Johannigman JA, Davis K, Campbell RS, Branson RD, Luchette FA, Hurst JM. Use of the rapid shallow breathing index as an indicator of patient work of breathing during pressure support ventilation. Surgery 1997;122(4):737–740. DOI: 10.1016/s0039-6060(97)90081-7.
  18. Soleimanpour H, Taghizadieh A, Salimi R, Golzari SE, Mahmoodpoor A, Safari S, et al. Rapid shallow breathing index survey, a predictor of non-invasive ventilation necessity in patients with chronic obstructive pulmonary disease exacerbation: an analytical descriptive prospective study. Iran Red Crescent Med J 2014;16(2):e13326. DOI: 10.5812/ircmj.13326.
  19. Aliverti A, Carlesso E, Dellacà R, Pelosi P, Chiumello D, Pedotti A, et al. Chest wall mechanics during pressure support ventilation. Crit Care 2006;10(2):R54. DOI: 10.1186/cc4867.
  20. Banner MJ, Kirby RR, Kirton OC, DeHaven CB, Blanch PB. Breathing frequency and pattern are poor predictors of work of breathing in patients receiving pressure support ventilation. Chest 1995;108(5):1338–1344. DOI: 10.1378/chest.108.5.1338.
  21. Gonçalves EC, Silva EC, Basile Filho A, Auxiliadora-Martins M, Nicolini EA, Gastaldi AC. Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation. Rev Bras Fisioter 2012;16(5):368–374. DOI: 10.1590/s1413-35552012005000037.
  22. Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, et al. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care 2016;20(1):226. DOI: 10.1186/s13054-016-1396-0.
  23. Campbell ML, Templin T, Walch J. A respiratory distress observation scale for patients unable to self-report dyspnea. J Palliat Med 2010;13(3):285–290. DOI: 10.1089/jpm.2009.0229.
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