Abstract
Proportional assist ventilation (PAV) is a form of synchronized partial ventilatory support in which the ventilator generates pressure in proportion to the patient’s instantaneous effort, and this proportionality applies from breath to breath as well as continuously throughout each inspiration [1]. In effect, patient effort is amplified, as if the patient has acquired additional inspiratory muscles that remain under the control of the patient’s own respiratory control system (Fig. 3.1).
Supported by the Respiratory Health Network of Centres of Excellence (INSPIRAPLEX) and by the Medical Research Council of Canada Proportional Assist Ventilation and PAV are trademarks of the University of Manitoba
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References
Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support: theory. Am Rev Respir Dis 145: 114–120
Remmers JE, Gautier H (1976) Servorespirator constructed from a positive pressure ventilator. J AppI Physiol 41: 252–256
Daubenspeck JA, Pichon D, Knuth KV, Bartlett D jr, St John WM (1988) An inexpensive servorespirator based upon regulation of a shunt resistance. Respir Physiol 73: 87–96
Younes M, Puddy A, Roberts D, Light RB, Quesada A, Taylor K, Oppenheimer L, Cramp H (1992) Proportional assist ventilation: results of an initial clinical trial. Am Rev Respir Dis 145: 121–129
Poon CS, Ward SA (1986) A device to provide respiratory mechanical unloading. IEEE Trans Biomed Eng 33: 361–365
Schulze A, Schaller P, Gehrhardt B, Madler H-J, Gmyrek D (1990) An infant ventilator technique for resistive unloading during spontaneous breathing. Results in a rabbit model of airway obstruction. Pediatr Res 28: 79–82
Black LF, Hyatt RE (1969) Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 99: 696–702
Rochester DF, Braun NMT (1985) Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 132: 42–47
Boczkowski J, Aubier M (1995) The respiratory muscles in sepsis. In: Roussos C (ed) The thorax. Lung biology in health and disease, vol 85, chap 51. Dekker, New York, pp 1483–1513
McParland C, Krishnan B, Wang Y, Gallagher CG (1992) Inspiratory muscle weakness and dyspnea in chronic heart failure. Am Rev Respir Dis 146: 467–472
Lewis MT, Belman MJ (1988) Nutrition and the respiratory muscles. Clin Chest Med 9: 337–348
Aldrich TK, Prezant DJ (1990) Adverse effect of drugs on the respiratory muscles. Clin Chest Med 11: 177–189
Younes M (1990) Load responses, dyspnea and respiratory failure. “State of the art.” Chest 97: 595–685
Younes M (1994) Proportional assist ventilation. In: Tobin M (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 349–370
Harries JR, Tyler JM (1964) Mechanical assistance to respiration in emphysema. Am J Med 36: 68–78
Stawitcke FA, Mordan WJ, Jimison HB, Piziali R, Ream AK (May 15, 1984 ) Medical ventilator device parametrically controlled for patient ventilation. U.S. Patent 4, 448, 192
Etherington TJ, Greene JG, Poon CS, Storsved M (1988) A new means of ventilation. The Negative Impedance Respirator. Biomed Sci Instrum 24: 209–215
Huang KA(1985) A microprocessor-based servo-respirator with synchronized airflow pattern. MSc Thesis, North Dakota State University of Agriculture and Applied Science, Fargo, ND
Younes M (1992) Proportional assist and negative impedance ventilation (letter to the editor). Am Rev Respir Dis 146: 1642–1643
Younes M (1991) Proportional assist ventilation and pressure support ventilation: similarities and differences. In: Update in Intensive Care and Emergency Medicine, vol 15. Springer, Berlin Heidelberg New York, pp 361–380
Younes M (1993) Patient-ventilator interaction with pressure-assisted modalities of ventilatory support. Semin Respir Med 14: 299–322
Younes M (1995) Interactions between patients and ventilators. In: Roussos C (ed) The thorax. Lung biology in health and disease, vol 85, chap 81. Dekker, New York, pp 2367–2420
Jammes Y, Auran Y, Gouvermet J, Delpierre S, Grimaud C (1979) The ventilatory pattern of conscious man according to age and morphology. Bull Eur Physiopathol Respir 15: 527–540
Marantz S, Patrick W, Webster K, Roberts D, Oppenheimer L, Younes M (1996) Response of ventilator-dependent patients to different levels of proportional assist ( PAV ). J Appl Physiol 80: 397–403
Patrick W, Webster K, Ludwig L, Roberts D, Wiebe P, Younes M (1996) Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure. Am J Respir Crit Care Med 153: 1005–1011
Navalesi P, Hernandez P, Wongsa A, Laporta D, Goldberg P, Gottfried SB (1996) Proportional assist ventilation in acute respiratory failure: effects on breathing pattern and inspiratory effort. Am J Respir Crit Care Med 154: 1330–1338
Ranieri VM, Giuliani R, Mascia L, Grasso S, Petruzzelli V, Puntillo N, Perchiazzi G, Fiore T, Brienza A (1996) Patient ventilator interaction during acute hypercapnia: pressure support vs proportional assist ventilation. J Appl Physiol 81: 426–436
Meza S, Giannouli E, Younes M (1995) Ventilatory response to inspiratory muscle unloading with PAV (proportional assist) during sleep. Am J Respir Crit Care Med 151: A639
Giannouli E, Webster K, Patrick W, Roberts D, Younes M (1994) Determination of dynamic hyperinflation in patients on synchronized (assist) methods of ventilatory support. Am J Respir Crit Care Med 149: A72
Giannouli E, Webster K, Roberts D, Younes M (1999) Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med 159: 1716–1725
Patrick W, Webster K, Wiebe P, Roberts D, Light B, Oppenheimer L, Kassum D, Younes M (1993) Effect of proportional assist ventilation on the hemodynamics of patients in septic shock. Am J Respir Grit Care Med 147: A611
Mettias M, Mendoza M, Wiebe P, Younes M, Light B (1993) Effect of proportional assist ventilation (PAV) vs controlled mandatory and pressure support ventilation (CMV, PSV) on gas exchange in patients with hypoxemic respiratory failure. Clin Invest Med 16: B23
Georgopoulos D, Webster K. Mitrouska I, Bshouty Z, Younes M (1995) Effect of inspiratory muscle unloading on the ventilatory response to CO2 Am J Respir Crit Care Med 151: A639
Rimmer KP, Rose MS, Hecker Js, Whitelaw WA (1995) Effect of proportional assist ventilation on ventilatory response to CO, Am J Respir Crit Care Med 151: A639
Chrusch C, Bauerle O, Younes M (1996) The effect of proportional assist ventilation (PAV) on exercise endurance time in COPD. Am J Respir Crit Care Med 153: A171
Hernandez P, Maltais F, Gursahaney A, LeBlanc P, Navalesi P, Gottfried SB (1996) Proportional assist ventilation ( PAV) improves exercise performance in severe COPD. Am J Respir Crit Care Med 153: A172
Appendini L, Purro A, Patessio A, Zanaboni S, Polese G, Donner CF, Rossi A (1996) CPAP improves ventilatory assistance with proportional assist ventilation ( PAV) in COPD patients. Am J Respir Crit Care Med 153: A380
Mendez M, Fernandez R, Younes M (1996) Changes in respiratory motor output with different levels of volume-cycled, pressure support and proportional assist ventilation in normal subjects. Am J Respir Crit Care Med 153: A375
Puntillo F, Vitale N, Grasso S, Mascia L, Giuliani R, Tunzi P, Cicale P, DeLuca Tupputi L, Fiore T, Ranieri M (1996) Compensation for increase in elastic load during pressure assisted modes (part 1). Am J Respir Crit Care Med 153: A373
Grasso S, Puntillo F, Mascia L, Ancona G, Fiore T, Bruno F, Slutsky AS, Ranieri M (2000) Compensation for increase in respiratory workload during mechanical ventilation. Pressure support versus proportional-assist ventilation. Am J Respir Grit Care Med 161: 819–826
Gursahaney A, Mirkovic T, Hernandez P, Navalesi P, Laporta D, Goldberg, P, Gottfried SB (1996) Comparison of airway opening and tracheal pressure regulated forms of proportional assist ventilation ( PAV ). Am J Respir Crit Care Med 153: A372
Gursahaney A, Mirkovic T, Hernandez P, Laporta D, Goldberg P, Gottfried SB (1996) Proportional assist ventilation (PAV) improves breathing pattern and inspiratory effort in acute respiratory failure (ARF). Am J Respir Crit Care Med 153: A372
Appendini L, Purro A, Zanaboni S, Patessio A, Spada E, Carone M, Polese G, Ganassini A, Donner CF, Rossi A (1996) Effects of endotracheal tube (ET) on patient-ventilator interactions during proportional assist ventilation ( PAV) in COED patients. Am J Respir Crit Care Med 153: A373
Fink BR, Hanks EC, Ngal EH, Papper EM (1963) Central regulation of respiration during anesthesia and wakefulness. Ann NY Acad Sci 190: 892–899
Skatrud SJ, Dempsey JA (1983) Interaction of sleep state and chemical stimuli in sustaining rhythmic ventilation. J Appl Physiol 55: 813–22
Tobin M (1990) Weaning from mechanical ventilation. Curr Pulmonology 11: 47–105
Hey EN, Lloyd BB, Cunningham DJC, Jukes MGM, Bolton DPG (1966) Effects of various respiratory stimuli on the depth and frequency of breathing in man. Respir Physiol 1: 193–205
Marini JJ (1990) Lung mechanics determination at the bedside: instrumentation and clinical application. Respir Care 35: 669–696
Guerin C Coussa ML, Eissa NT, Corbeil C, Chasse M, Braidy J, Matar N, Milic-Emili J (1993) Lung and chest wall mechanics in mechanically ventilated COPD patients. J Appl Physiol 74: 1570–1580
Wright PE, Marini JJ, Bernard GR (1989) In vitro versus in vivo comparison of endotracheal tube airflow resistance. Am Rev Respir Dis 140: 10–16
Agostoni E, Mead J (1964) Statics of the respiratory system. In: Handbook of physiology. Respiration, sect 3, vol 1, chap 13. Am Physiol Soc., Washington DC, pp 387–409
Mead J, Agostoni E (1964) Dynamics of breathing. In: Handbook of physiology. Respiration, sect 3, vol 1, chap 14. Am Physiol Soc., Washington DC, pp 411–427
Newsom-Davis J, Stag. D (1975) Interrelationships of the volume and time components of individual breaths in resting man. J Physiol (Lond) 245: 481–498
Tobin MJ, Mador MJ, Guenther SM, et al (1988) Variability of resting respiratory drive and timing in healthy subjects. J Appl Physiol 65: 309–317
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Younes, M. (2003). Proportional Assist Ventilation. In: Mancebo, J., Net, A., Brochard, L. (eds) Mechanical Ventilation and Weaning. Update in Intensive Care Medicine, vol 36. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56112-2_3
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DOI: https://doi.org/10.1007/978-3-642-56112-2_3
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