Proportional Pressure Support Ventilation - Proportional Pressure Support Ventilation

Proportional Pressure Support Ventilation

As Your Specialist in Acute Care, we understand the importance of allowing the patient to take control of ventilation through Proportional Pressure Support (PPS). PPS applies patient-triggered pressure support in proportion to the patient’s inspiratory effort. Essentially, the result is a reduction in resistive and elastic work of breathing and can be used in both intubated and non-invasively supported patients.

Proven facts: Improved Outcome with Proportional Pressure Support Ventilation

  • Proportional ventilation results in fewer patient-ventilator asynchronies and better quality of sleep.1
  • Proportional pressure support reduces asynchronies, ventilation time and length of ICU stay.2
  • Proportional ventilation facilitates exercise and could enhance the training effect and facilitate rehabilitation.3

References/ Sources

  1.  Bosma K et al., Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation., Crit Care Med. 2007 Apr;35(4):1048-54.
  2. Yin C et al., Comparison of the effect of CPAP+PPS mode and CPAP+ASB mode in weaning on acute exacerbation of chronic obstructive pulmonary disease patients, Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Oct;30(10):939-942. doi: 10.3760/cma.j.issn.2095-4352.2018.10.006.
  3. Akoumianaki E et al., Can proportional ventilation modes facilitate exercise in critically ill patients? A physiological cross-over study : Pressure support versus proportional ventilation during lower limb exercise in ventilated critically ill patients., Ann Intensive Care. 2017 Dec;7(1):64. doi: 10.1186/s13613-017-0289-y. Epub 2017 Jun 12.
Proportional Pressure Support: How does it work?

The idea of Proportional Pressure Support

Proportional Pressure Support (PPS) is a form of breathing support for patients whose spontaneous breathing efforts still require assistance or whose work of breathing is increased as a result of higher resistance and/or lower compliance. The pressure support is provided proportionately to the work of breathing throughout inspiration and the patient’s needs are directly and continuously met: If the patient’s breathing is shallow, little support is provided. More support is applied for a deep breath. The absolute amount of support depends on both the Flow Assist and Volume Assist parameter settings as well as the patient.

The picture below shows different inspiratory efforts which result in different levels of flow. While the support during Pressure Support (PS) always remains constant, in PPS support is provided proportionally. This proportional delivery results in support being provided only when it is needed.

The use of Volume Assist and Flow Assist

The two types of pressure support, pressure support proportional to volume (Volume Assist) and pressure support proportional to flow (Flow Assist) can be combined. Flow Assist and Volume Assist are set by the user, the ventilator’s microprocessor calculates continuously at each point of the breathing cycle the proportional pressure support for the patient. If set correctly, only the illness-related higher work of breathing is continuously adapted and compensated – the physiological work of breathing continues to be provided by the patient alone.
Flow Assist helps overcome the resistance and the pressure support is proportional to the flow. In contrast, Volume Assist compensates the elastic resistance (C) caused by reduced elasticity of the lungs. The pressure support is proportional to the tidal volume. The relationship between the inspiratory effort and the pressure support remains constant for the same settings, while the pressure support varies for every breath. If no spontaneous breathing is detected, the mechanical support also ceases. Adequate apnoea and minute volume monitoring must therefore be in place.

What customers say about PPS in clinical use

PPS at Central Hospital Karlstad - Sweden

At Karlstad Sweden Hospital, Proportional Pressure Support (PPS) is an appreciated mode of ventilation used in the Intensive Care Unit. It mimics a more “natural” form of breathing and gives patients a great deal of control.

Successful ventilation weaning with PPS - Germany

Respiratory support proportional to respiratory drive for patients with spontaneous breathing: Beatrice Totten, Senior Physician in the Department of Internal Medicine and Rheumatology of the St. Ansgar Hospital Sulingen, talks about her experience with weaning in patients with a severe pulmonary disease and the advantages of PPS.

Facilitate weaning from the ventilator with PPS - USA

Clinicians successfully match patient’s respiratory demands and facilitate weaning by using PPS. The patient is a 72-year old female with acute respiratory failure, hypoxia, lactic acidosis, septic shock, and acute renal failure.Get more information about her case.

Clinical evidence on Proportional Pressure Support

Literature List PPS
Literature List PPS 2020

Clinical studies and publications with regards to proportional pressure support ventilation

Respiratory Pathway

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