Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube

Abstract

Breathing through an endotracheal tube and a demand valve may increase the work performed by the respiratory muscles. Inspiratory pressure support (PS) is known to reduce this work and might therefore compensate for this increased requirement. To test this hypothesis, we measured the work of breathing (WOB) in 11 patients whose tracheas were intubated. Five had no intrinsic lung disease, but six had chronic obstructive lung disease. We compared WOB measurements taken under several sets of conditions: during assisted breathing at four levels of PS, during unassisted breathing and connection to a T-piece, and after extubation of the trachea. During unassisted breathing via the ventilator circuit (PS set at 0 cmH20), the WOB per minute was greater than that after extubation, with a mean increase (± standard deviation) of 68 ± 38% (10.3 ± 5.1 vs. 6.5 ± 3.7 J·min-1, P < 0.01). While breathing through the T-piece, the WOB was 27 ± 18% greater than after tracheal extubation (8.2 ± 5.1 vs. 6.5 ± 3.7 J·min-1, P < 0.05). The principal reason why inspiratory work decreased after extubation was that the ventilatory requirement decreased. For each patient, we determined retrospectively, after extubation, the level of PS that had reduced WOB to its postextubation value and obtained levels ranging from 3.4 to 14.4 cmH2O. The PS level at which additional WOB was compensated for, was greater in patients with chronic lung disease than in those free of lung disease (12.0 ± 1.9 vs. 5.7 ± 1.5 cm H2O, P < 0.05). These results suggest that PS can be used to compensate for the additional WOB caused by the endotracheal tube and demand valve but that pressure requirements differs substantially among patients, depending on the presence or absence of respiratory disease.