Pressure vs flow triggering during pressure support ventilation

Background: Adult mechanical ventilators have traditionally been pressure- or time-triggered. More recently, flow triggering has become available and some adult ventilators allow the choice between pressure or flow triggering, Prior studies have supported the superiority of flow triggering during continuous positive airway pressure, but few have compared pressure and flow triggering during pressure support ventilation (PSV). The purpose of this study was to compare pressure and flow triggering during PSV in adult mechanically ventilated patients. Methods: The study population consisted of 10 adult patients ventilated with a mechanical ventilator (Nellcor-Puritan-Bennett 7200ae) in the PSV mode. In random order, we compared pressure triggering of -0.5 H2O, pressure triggering -1 cm H2O, flow triggering of 5/2 L/min, and flow triggering 10/3 L/min. Pressure was measured for 5 min at the proximal endotracheal tube using a data acquisition rate of 100 Hz. From the airway pressure signal, trigger pressure (Delta P) was defined as the difference between positive end-expiratory pressure (PEEP) and the maximum negative deflection prior to onset of the triggered breath. Pressure-time product (PTP) was defined as the area produced by the pressure waveform below PEEP during onset of the triggered breath, Trigger time (Delta T) was defined as the time interval below PEEP during onset of the triggered breath. Results: A pressure trigger of -0.5 cm H2O was significantly more sensitive than the other trigger methods for Delta P, PTP, and Delta T (p<0.001), There was also a significant difference between patients for Delta P, Delta T, and PTP for each trigger method (p<0.001). Conclusions: For this group of patients, flow triggering was not superior to pressure triggering at -0.5 cm H2O during PSV.