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Effects of Continuous Positive Airway Pressure Level on Respiratory Mechanics and Central Drive during Dynamic Hyperinflation

Author: ZhuChuanBing
Tutor: ChenRongChang
School: Guangzhou Medical College
Course: Internal Medicine
Keywords: Chronic obstructive pulmonary disease Dynamic lung hyperinflation Endogenous end-expiratory pressure Continuous positive airway pressure Central drive
CLC: R563.9
Type: Master's thesis
Year: 2011
Downloads: 18
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Background: expiratory flow limitation (EFL) is a dynamic lung hyperinflation (DPH) and endogenous important mechanism of positive end-expiratory pressure (PEEPi). DPH and PEEPi increase the inspiratory threshold load, lower inspiratory muscle (the diaphragm) function, inspiratory muscle efforts to increase and hub - machinery - ventilation uncoupling and increased difficulty in breathing. Plus an appropriate level of exogenous positive end-expiratory pressure (PEEPe) can reduce inspiratory muscle effort of mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD), lower respiratory power consumption, to improve the human-machine coordination. PEEPe level of respiratory mechanics, especially central - machinery - ventilation coupled remains to be further studied. Objective: breath-limiting in healthy subjects to establish EFL model, analog COPD pathophysiology, explore different continuous positive airway pressure (CPAP) level EFL when end-expiratory lung volume (EELV) the combined effects of the hub - Mechanical - ventilation coupled and breathing difficulties. Subjects chest wall and lung static compliance curve: slow deep breathing to build the pressure-volume curve of the lung and the chest (Campbell) Figure; use breath-limiting analog EFL, relatively limited lung capacity before and after the flow / flow, breathing mechanical index and diaphragmatic EMG, central - machinery - ventilation coupled change; subjects when using CPAP, in the current limit on the basis of acquisition different levels of pressure changes in these indicators compare different CPAP levels of these indicators. Establishment of: 1.COPD pathophysiological model: limiting subjects breathing difficulties, and performance similar to the COPD pathophysiology, such as airflow limitation, dynamic lung hyperinflation (inspiratory capacity ( IC) decreases P lt; 0.001) appear static endogenous positive end-expiratory pressure (PEEPi, stat 4.94 ± 1.33 cmH 2 O), accessory muscle use increases (tidal breathing esophageal pressure and transdiaphragmatic pressure changes in the ratio of (△ Pes / △ Pdi) increased, P lt; 0.05) increase in central drive (RMSdi RMSdi% higher, P lt; 0.01), central - machinery - ventilation coupled deterioration (VT / RMS, VT / △ Pes decreased P lt; 0.01; △ Pdi / RMS, P lt; 0.05). However, there is not change in patients with COPD, performance trend increase in tidal volume (VT) (from 0.74 ± 0.11L to 1.03 ± 0.27L, P gt; 0.05), respiratory rate (RR) decreased (P lt; 0.01). COPD model 2.CPAP COPD model of respiratory mechanics: with CPAP level increases, changes in end-expiratory lung volume value (ΔEELVx) of its share of the current limiting inspiratory capacity after the percentage (ICx) (ΔEELVx / ICx%) S-shaped curve, less than in the CPAP PEEPi stat of 73.95% increase in the more moderate, with CPAP increased significantly increase when the CPAP exceeds this limit value; RMSdi RMSdi% and rising; hub - machinery - ventilation the coupling indicator - tidal volume and diaphragmatic electrical activity intensity ratio (VT / RMS), minute ventilation, and diaphragmatic electrical activity intensity ratio (VE / RMS), the intensity ratio of transdiaphragmatic pressure and diaphragm electrical activity (ΔPdi / RMS), the tidal volume transdiaphragmatic pressure ratio (VT / ΔPdi), tidal volume and esophageal suction negative pressure ratio (VT / ΔPes) have decreased, but the comparison between groups was not statistically significant. Correlation and regression relationship between the evaluation: With CPAP gradually increasing, reflecting the indicators of the respiratory center drive, diaphragmatic EMG activity intensity accounted for the largest percentage of the activity intensity (RMSdi%) and the mean inspiratory flow (VT / Ti) increase, and shortness of breath score (Borg) experiment was a positive correlation, negative correlation with the IC; reflect hub - machinery - ventilation coupled indicators, including of VT / ΔPes, ΔPdi / RMS, VT / RMS Borg score was negatively correlated positively correlated with the IC. Diaphragmatic activities need to reflect the flow trigger indicators the - RMSdi inhale start to the integral value of the flow rate of up to 40ml / s and achieve volume ratio (ΣRMS / V) IC, VT / ΔPes, ΔPdi / RMS, VT / RMS was negatively correlated, suggesting that the the diaphragmatic EMG integral value of the suction initial segment can well reflect the central drive change. Five predictors of the Borg score as the dependent variable, stepwise selection of multiple independent variables: RMSdi% ΔPdi / RMS, VT / RMS ΔPes, VT / Ti, the coefficient of determination (R 2 ) was 0.614; to ΔEELVx or IC as the dependent variable, stepwise selection two predictors: of CPAP / PEEPi, stat, expiratory time (Te), the R 2 , respectively, 0.666 and 0.718. Conclusion: 1. Limiting can cause expiratory flow limitation to lead dynamic lung hyperinflation and PEEPi formation COPD model was successfully established in normal subjects. This model can cause respiratory muscle efforts, accessory muscle use, respiratory center drive enhanced hub - Mechanical - ventilation coupled deterioration, difficulty in breathing. COPD model of normal subjects, increases with the CPAP level, end-expiratory lung volume was non-linear increase in CPAP less than PEEPi stat 73.95% when end-expiratory lung volume increased minor when CPAP exceed this limit value, the increase in the level of CPAP led to a significant increase in end-expiratory lung volume. CPAP does not improve hub - Mechanical - ventilation coupling. The results of this study do not support the use of the central - Machinery - ventilation coupled to a reasonable set of guiding CPAP. CPAP (PEEP) level settings should pay more attention to the monitoring of end-expiratory lung capacity and dyspnea.

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