LOREM IPSUM

2. ÜBERSCHRIFT®

3. Überschrift

Lorem ipsum dies ist eine lange Beschreibung über mehrer Zeilen

die weiteren Punkte sind alle durch eine Linie getrennt

der Zeilenabstand ist immer gleichbleibend 9,5 pt

es gibt keine untersch. Zeilenab-stände mehr

Lorem ipsum O2 Ullamcorper suscipit lobortis 10 %

1 Fußnote

Proportional Pressure Support (PPS)Clinicians successfully match patient’s respiratory demands and facilitate weaning by using PPS –A Case Study

D-7

6319

-201

3

Brian Stewart, BA, RRT, NPSAdult Critical Care CoordinatorCarle Foundation Hospital

PROPORTIONAL PRESSURE SUPPORT (PPS)2 |

The patient is a 72-year old female transferred to our facility with acute respiratory failure, hypoxia, lactic acidosis, septic shock, and acute renal failure. Her history includes significant COPD, CVA, diabetes mellitus type 2, tardive dyskinesia, hyperlipidemia, hypothyroidism, and depression. After being sedated with Propofol and Fentanyl, she was started on Levophed and IV fluids. Her respiratory rate was 33 with obvious accessory muscle use. Her arterial blood gas showed a severe metabolic acidemia.

INITIAL ARTERIAL BLOOD GAS RESULTS:

pH 7.01PaCO

2 15

PaO2 182

HCO3 3.7

BE -25.7

INITIAL VENTILATOR SETTINGS

Application Mode VC/AC with AutoFlowTidal volume (Vt) 400 ml (8 ml/kg of ideal body weight)Respiratory Rate 14, PEEP 8FiO2 1.0

Figure 1: Initial chest X-ray

| 3

The initial mode of ventilation was VC/AC with AutoFlow. Given the erratic spontaneous breathing despite moderate sedation, this approach needed to be altered for the condition at hand. To help correct her acidemia, the patient was taking larger than set tidal volumes (Vt). The patient’s respiratory drive needed to control the level of support provided by the ventilator.

The mode of ventilation was changed to Proportional Pressure Support (PPS). The thought was to allow the patient to take control of ventilation. As the acidemia resolves, her respiratory drive should decrease, as would Vt and spontaneous rate.

Figure 2: Initial ventilator settings

PROPORTIONAL PRESSURE SUPPORT (PPS)4 |

The patient was able to take the Vt she desired. Her accessory muscle use diminished and she appeared much more comfortable. Initial PPS settings were 8 of flow assist and 8 of volume assist. Over a period of time, the flow assist control was adjusted to 4 and the volume assist was adjusted to 13.5. Automatic Tube Compensation was also added to overcome the patient’s resistance to the endotracheal tube.

Figure 3: Initial PPS settings

| 5

As the patient’s acidemia resolved, the PPS settings were manipulated based on work of breathing, airway resistance, and compliance. Flow assist was set to 5.5 and Volume assist was adjusted to 12.0 by the next morning. The patient’s peak inspiratory pressure, (PIP) had dropped from 30 to 12. Spontaneous tidal volumes were much more variable, and her spontaneous respiratory rate improved to the low 20/min.

Figure 4: Addition of Automatic Tube Compensation

PROPORTIONAL PRESSURE SUPPORT (PPS)6 |

ABG RESULTS SHOW AN IMPROVED ACID BASE BALANCE:

pH 7.38PCO2 25PO2 114HCO3 14.1BE -9.6

The patient was kept on PPS mode until she was alert. The clinical team believed that the patient could be extubated at this time. At this point the patient was placed on CPAP with pressure support for a brief sponta-neous breathing trial and extubated.

Figure 5: Variable Tidal Volumes (Day 2)

| 7

Brian Stewart has been a Respiratory Therapist since 1991. He is currently the Adult Critical Care Coordinator at Carle Foundation Hospital in Urbana, IL. His passion is to research potential therapies and seeing positive outcomes after bringing them into everyday practice.

ConclusionProportional Pressure Support (PPS) can be a useful mode when the patient requires breath by breath adap-tion to support their own inspiratory demands, while unloading work of breathing. In this case, supporting the patient’s spontaneous breathing in proportion to her effort allowed for effective management. Through the use of PPS, the clinicians were able to match the patient’s respiratory demands and facilitate weaning from the ventilator.

CORPORATE HEADQUARTERSDrägerwerk AG & Co. KGaAMoislinger Allee 53–5523558 Lübeck, Germany

www.draeger.com

Manufacturer:Drägerwerk AG & Co. KGaAMoislinger Allee 53–5523558 Lübeck, Germany

USADraeger, Inc.3135 Quarry Road Telford, PA 18969-1042Tel +1 800 4DRAGER(+1 800 437 2437)Fax +1 215 723 5935info.usa@draeger.com

CANADADraeger Medical Canada Inc.2425 Skymark Avenue, Unit 1Mississauga, Ontario, L4W 4Y6Tel +1 905 212-6600Toll-free +1 866 343 2273Fax +1 905 212-6601Canada.support@draeger.com

Locate your Regional Sales Representative at: www.draeger.com/contact

91 0

5 15

4 |

18.0

1-5

| S

L |

Sub

ject

to m

odifi

catio

ns |

© 2

018

Drä

gerw

erk

AG &

Co.

KG

aA