Activation of Automatic Tube Compensation Mode Attenuates Auto‐PEEP in Chronic Obstructive Pulmonary Disease Patients

Abstract

ABSTRACT Introduction Dynamic hyperinflation in chronic obstructive pulmonary disease (COPD) results in intrinsic positive end‐expiratory pressure (auto‐PEEP). Automatic tube compensation (ATC) is used to increase airway pressure in COPD and overcome endotracheal tube (ETT)–imposed respiratory workload. We aim to investigate effects of ATC activation on auto‐PEEP decrease in COPD. Methods ATC was activated three times a day (1 min duration) in the morning, evening, and night shift. Auto‐PEEP was measured for the 1 min period (every 6 s) following ATC activation. Linear mixed model (LMM) was used to measure changes in auto‐PEEP and compare with baseline value. Age, gender, and COPD types were inserted in model as covariates and analyzed using SPSS. Results A total of 60 patients including COPD (n = 40) and COPD with exacerbation (n = 20) were included. Compared with exacerbated COPD, baseline auto‐PEEP in COPD was significantly lower in morning (p = 0.011), evening (p = 0.043), and night shift (p = 0.007). After ATC activation, auto‐PEEP decreased significantly in COPD in morning, evening, and night (p = 0.001), but magnitude of this decrease was notably larger in COPD than in exacerbated COPD (p = 0.001). Moreover, there was a significant relationship between COPD exacerbation and changes in auto‐PEEP in morning (β = −0.27, p = 0.001), evening (β = −0.16, p = 0.001), and night (β = −0.26, p = 0.001). Conclusion The activation of ATC mode in COPD patients under mechanical ventilation could decrease the value of auto‐PEEP. Nevertheless, COPD patients with an exacerbation appear to benefit less from ATC activation.

Keywords

• automatic tube compensation
• auto‐PEEP
• COPD
• mechanical ventilation