EXCESSIVE WORK OF BREATHING DURING INTERMITTENT MANDATORY VENTILATION

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Abstract
Difficulties were experienced in weaning a patient from a ventilator by means of intermittent mandatory ventilation (IMV). The difficulty was overcome by installing an alternative IMV system (Hudson “disposable IMV valve”) through which the patient drew her spontaneous breaths. Laboratory measurements showed that the resistance of the ventilator breathing system was much higher than that of the alternative system, mainly as a result of the resistance of the humidifier. It was calculated from measurements with a preset pattern of simulated breathing that the extra, external, work of breathing through the ventilator breathing system was approximately 1.5 times the normal internal mechanical work of breathing for a normal patient; with the alternative system, the extra work was only 0.5 times the normal. It is stressed that the breathing systems of IMV ventilators should be judged with the same rigour as other systems through which the patient is required to breathespontaneously. It is recommended that manufacturers should pro vide the necessary information.