Thursday, February 26, 2009

Clinical Application of P0.1

  • Click on the picture for a larger image. 
Notice in the above pictured graph the dramatic increase in both p0.1 (blue) and work of breathing (yellow) after switching the patient to a low tidal volume strategy.

Maintaining this strategy in this referenced patient would put them at risk for:
  •  muscle fatigue
  • ventilator asynchronies
  •  higher sedation use
  • prolonged mechanical ventilation. 

"Forcing a tidal volume of 6 ml/kg on every patient can result in marked cardiovascular instability, as a result of the patient fighting the ventilator for a larger tidal volume. This increases the patients effort, discomfort, oxygen consumption, carbon dioxide production, and increases the complexity of managing the patient" (Kacmarek, R 2007). 

If the p0.1 is too high
  • Decrease the trigger sensitivity.
  • Shorten rise time (faster).
  • Increase Flow rate.
  • Change to a pressure mode.
  • Increase the Driving pressure.
  • Consider Proportional Assist Ventilation or Adaptive Support Ventilation. 
Grooms, D. (2006). P0.1 Trending to Evaluate Target Vt Settings. Excel Graph. Norfolk General Hospital. Norfolk, VA.