Publication: Breathing comfort associated with different modes of ventilation: A comparative study in non-intubated healthy Nepalese volunteers
Date
2007
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Objective: To compare subjective experience of comfort associated with various commonly used supportive modes
of mechanical ventilation for weaning in the intensive care unit (ICU).
Subjects and Methods: The study was carried out in general ICU of a community-based teaching hospital in 30
healthy adult Nepalese volunteers of either sex and 19-37 years of age. The subjects were randomly made to
experience breathing via anatomical facemask through ventilator circuit with synchronized intermittent mandatory
ventilation (SIMV), assisted spontaneous breathing (ASB), biphasic positive airway pressure (BiPAP), and
continuous positive airway pressure (CPAP) modes of ventilation with parameters set at intermediate level of
respiratory support. Subjective comfort of breathing was noted using a 10cm visual analogue scale (VAS) with no
discomfort at one end and maximum imaginable discomfort at the other. Inspiratory and expiratory experience of
discomfort was also noted using a four point ranking scale (0-no discomfort, 1-mild discomfort, 2-moderate
discomfort and 3-severe discomfort). In addition, presence or absence of feeling of breathlessness and inflation was
also noted.
Results: BiPAP was the most comfortable mode of ventilation (p<0.01) on visual analogue scale. SIMV and CPAP
modes were associated with higher discomfort than other modes during inspiratory and expiratory phases
respectively. Breathlessness and inflation were least felt in BiPAP and SIMV modes respectively.
Conclusion: Perception of breathing comfort can vary widely with various supportive modes of ventilation in the
ICU. Hence, no single supportive mode should be used in all patients during weaning from mechanical ventilation.
Key words: assisted spontaneous breathing; biphasic positive airway pressure; breathing comfort; continuous
positive airway pressure; mechanical ventilation; supportive modes synchronized intermittent mandatory ventilation;
weaning
Description
Baral PR 1, Bhattarai B2, Pande R 3, Bhadani U 4, Bhattacharya A 5, Tripathi M 6
1 Lecturer, Department of Anaesthesiology, Kathmandu University Medical School, B & B Teaching Hospital, 2,3,4Associate Professors, 5Professor, 6Additional Professor Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal.