Ventilator Settings Can Substantially Impact Patients' Comfort

Spyridon Fortis, Jorge Florindez, Shiva Balasingham, Manuel De Aguirre, Yaw Amoateng-Adjepong, Constantine A. Manthous

Research output: Contribution to journalArticle

Abstract

Background: With increasing realization that sedatives may complicate care of mechanically ventilated patients, greater emphasis might turn to promoting comfort by titration of ventilator settings. Hypothesis: Patients with acute on chronic respiratory failure (ACRF) with underlying chronic obstructive pulmonary disease (COPD) demonstrate different levels of comfort in response to varying ventilator settings compared to those with underlying obesity hypoventilation syndrome (OHS). Methods: Patients recovering from ACRF with underlying COPD or OHS were randomized to varying combinations of ventilator modes (assist control and pressure support), tidal volumes, and inspiratory flows for 3 minutes/setting. For each ventilator setting, physiologic variables were recorded and patients indicated their level of comfort using a 10-point Borg scale. Results: In all, 20 patients, aged 68±13 years (standard deviation) and ventilated for 4.9 days, were enrolled. Of 20 patients, 13 had COPD and 7 had OHS. No ventilator mode, flow, or tidal volume provided consistently greater comfort between the groups, but patients reported substantial ranges of comfort (up to 8 Borg points) across the ventilator settings studied. There were no significant differences in heart rate, blood pressure, or airway pressures within patients across ventilator settings or between the groups, but patients with OHS were more tachypneic compared to patients with COPD while breathing on assist control of 6 mL/kg (constant flow 60 L/min) and 8 mL/kg (decelerating flow 40 L/min). There was no correlation between comfort and systolic blood pressure, heart rate, or respiratory rate. Conclusion: Ventilator parameters may impact patients' comfort substantially. Future studies may help identify evidence-based methodology for gauging comfort following changes in ventilator settings and the settings that are most likely to positively impact various groups of patients.

Original languageEnglish (US)
Pages (from-to)286-291
Number of pages6
JournalJournal of Intensive Care Medicine
Volume30
Issue number5
DOIs
StatePublished - Jul 10 2015
Externally publishedYes

Keywords

  • anxiety
  • breathlessness
  • comfort
  • dyspnea
  • mechanical ventilation
  • sedation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Fortis, S., Florindez, J., Balasingham, S., Aguirre, M. D., Amoateng-Adjepong, Y., & Manthous, C. A. (2015). Ventilator Settings Can Substantially Impact Patients' Comfort. Journal of Intensive Care Medicine, 30(5), 286-291. https://doi.org/10.1177/0885066613519574