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Impact of inspiratory pressure rise time on lung-emptying in time controlled adaptive ventilation

Background: The airway pressure release ventilation (APRV)-based time controlled adaptive ventilation (TCAV) protocol can potentially minimize ventilator-induced lung injury (VILI). Inspiratory pressure rise time (IPRT) is a parameter available in pressure-controlled ventilation modes, yet its role...

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Main Authors: Neetz, Benjamin (Author) , Rehn, Patrick (Author) , Kraus, Nicole (Author) , Schmidt, Werner (Author) , Reinhardt, Lars (Author) , Flohr, Thomas (Author) , Laußer, Christoph (Author) , Weigand, Markus A. (Author) , Fiedler-Kalenka, Mascha (Author)
Format: Article (Journal)
Language:English
Published: 2025
In: Respiratory care
Year: 2025, Volume: 70, Issue: 12, Pages: 1547-1555
ISSN:1943-3654
DOI:10.1177/19433654251359959
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1177/19433654251359959
Verlag, lizenzpflichtig, Volltext: https://www.liebertpub.com/doi/10.1177/19433654251359959
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Author Notes:Benjamin Neetz, Patrick Rehn, Nicole Kraus, Werner Schmidt, Lars Reinhardt, Thomas Flohr, Christoph Laußer, Markus Alexander Weigand, Mascha O. Fiedler-Kalenka
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Summary:Background: The airway pressure release ventilation (APRV)-based time controlled adaptive ventilation (TCAV) protocol can potentially minimize ventilator-induced lung injury (VILI). Inspiratory pressure rise time (IPRT) is a parameter available in pressure-controlled ventilation modes, yet its role within TCAV remains unclear. We hypothesized that varying IPRTs impact lung emptying and associated ventilatory parameters (driving pressure [ΔP], intrinsic PEEP [PEEPi], exhaled tidal volume [VTe]). - Methods: This single-center, prospective exploratory study included 10 intubated subjects ventilated utilizing the TCAV protocol. Subjects underwent consecutive experimental trials with IPRTs of 500 and 1,000 ms, each preceded by a baseline (BL) with an IPRT of 0 ms. Analyzed parameters were ventilator-derived ΔP (ΔPvent), PEEPi, and VTe. Elastance (ERS = ΔPvent/VTe) and elastance-derived ΔP (ΔPelast = ERS × VTe) were calculated. End-expiratory lung volume (EELV) and end-inspiratory lung volume were assessed through electrical impedance tomography (EIT). - Results: Prolonged IPRT increased ΔPelast compared with ΔPvent in each baseline/trial combination (ΔPvent 13.5 ± 1.5 cm H2O vs ΔPelast 18.4 ± 2.7 cm H2O at 1,000 ms IPRT, P < .001) through a loss of PEEPi. Conventional PEEPi measurements did not detect these changes. The EIT data showed a reduction in EELV during the trials. - Conclusions: IPRT prolongation under TCAV reduced EELV/PEEPi, therefore increasing ΔP. Conventional PEEPi measurement methods are misleading in this context. We therefore suggest adding the recommendation to set IPRT to 0 ms for the TCAV protocol.
Item Description:Online veröffentlicht: 25. August 2025
Gesehen am 17.12.2025
Physical Description:Online Resource
ISSN:1943-3654
DOI:10.1177/19433654251359959

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