The use of intermittent mandatory ventilation (IMV) and positive end expiratory pressure (PEEP) may demand the patient mount an inspiratory pressure equivalent to the pressure level of the PEEP for spontaneous breathing. During respiratory failure, ineffective inspiratory muscles may be unable to consistently meet such demands, especially if high levels of PEEP are used. A technique which reduces the required inspiratory effort was devised for use in patients being treated with IMV and PEEP. Using this technique, isovolume inspiratory time was dramatically reduced and less inspiratory effort was required. This maneuver may assist spontaneous breathing in patients with respiratory failure on high levels of PEEP.
From the Pulmonary Division, Department of Medicine, UCSD School of Medicine, San Diego, Calif.
Dr. Brach is a NHLI Post-Doctoral Research Trainee in Pulmonary Disease (HL00134–02).