Key messages? Compared with PSV, BIPAP+SBmean resulted in: selleck chem Imatinib lower mean VT, comparable oxygenation and hemodynamics, and increased PaCO2 and inspiratory effort; less nonaerated areas at end-expiration; decreased tidal hyperaeration and reaeration; similar distributions of relative ventilation.? During BIPAP+SBmean: BIPAP+SBspont had lower VT and higher rate than BIPAP+SBcontrolled; BIPAP+SBspont and BIPAP+SBcontrolled had similar distributions of ventilation and aeration; BIPAP+SBcontrolled resulted in increased tidal reaeration and hyperareation, compared with PSV, while BIPAP+SBspont showed an opposite pattern.? The ratio between spontaneous to controlled breaths could play an important role in reducing tidal reaeration and hyperaeration during BIPAP+SBmean.
AbbreviationsALI: acute lung injury; ARDS: acute respiratory distress syndrome; BIPAP+SBcontrolled: time-cycled controlled breaths at two levels of continuous positive airway pressure during BIPAP+SBmean; BIPAP+SBmean: biphasic positive airway pressure with non-assisted spontaneous breathing; BIPAP+SBspont: non-assisted spontaneous breathing during BIPAP+SBmean; CT: computed tomography; CTdyn: dynamic computed tomography; FiO2: fraction of inspired oxygen; HU: Hounsfield units; I:E: inspiratory:expiratory ratio; P0.1: decay in airway pressure 100 ms after begin of the inspiration; PaCO2: partial pressure of arterial carbon dioxide; PaO2: partial pressure of arterial oxygen; Paw: airway pressure; PEEP: positive end-expiratory pressure; PEEPi,dyn: dynamic intrinsic end-expiratory pressure; Pmean: mean airway pressure; Ppeak: peak airway pressure; Ppl mean: mean transpulmonary pressure; PSV: pressure support ventilation; PTP: pressure versus time product of the inspiratory esophageal pressure; RR: respiratory rate; Ti/Ttot: inspiratory to total respiratory time; VT: tidal volume.
Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsAll authors made substantial contribution to the study design. MGA and MC drafted the manuscript and helped to perform the experiments. PM, ARC and CS helped to perform the experiments and contributed to drafting the manuscript. MC and VH developed the software for analysis of dynamic computed tomography scans and helped to draft the manuscript. BW performed the more complex multivariate statistical analysis and helped to draft the manuscript.
All other authors revised the manuscript for important intellectual content. All authors approved the final version of the manuscript for publication.Supplementary MaterialAdditional file 1:Calculation of mean airway pressures. This file shows exactly how the mean airway pressures were calculated for the different modes of assisted AV-951 ventilation, including the spontaneous and controlled cycles of biphasic positive airway pressure + spontaneous breathing (BIPAP+SBmean).
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