The Effects of Automatic Inspiratory Rise Time and Flow Termination on Operation of Closed-Loop Ventilation

Adaptive ventilation mode (AVM) is a automated mode of mechanical ventilation. AVM is comprable to adaptive support ventilation (ASV). Both recommend a tidal volume (V ) and breathing frequency (f) combination based on lung mechanics, but AVM also automatically adjusts rise time and flow termination...

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Bibliographic Details
Published in:Respiratory care 2023-05, Vol.68 (5), p.669-675
Main Authors: Yang, Shih Hsing, Wu, Chin Pyng, Huang, Yuh Chin T, Peng, Chung Kan
Format: Article
Language:English
Subjects:
Artificial respiration
Comparative analysis
Humans
Lung
Medical research
Medicine, Experimental
Observations
Original Research
Positive-Pressure Respiration
Respiration
Respiration, Artificial - methods
Respiratory physiology
Tidal Volume
Ventilators, Mechanical
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Summary:Adaptive ventilation mode (AVM) is a automated mode of mechanical ventilation. AVM is comprable to adaptive support ventilation (ASV). Both recommend a tidal volume (V ) and breathing frequency (f) combination based on lung mechanics, but AVM also automatically adjusts rise time and flow termination of pressure support breaths. How these added features of AVM affect V and f recommendations compared to ASV is not clear. The present study compared these 2 modes in a test lung with obstructive and restrictive mechanics. The experiment was performed in a simulated lung model in which the compliance (C) and resistance (R) could be altered independently. The ventilatory parameters at different minute volumes (MinVol%) in AVM or ASV mode were recorded. When MinVol% was set at 100%, AVM provided a similar V and f combination compared to ASV with decreasing compliance or increasing resistance. However, when MinVol% was increased to 250% simulating hyperventilation, for the severely obstructive lung (C60, R70) model, AVM provided a significantly higher f (26 ± 0.6 breaths/min vs 7.00 ± 0 breaths/min in ASV) and lower V (240 ± 80 mL vs 491 ± 131 mL in ASV). The addition of automatic control of rise time and flow termination functions did not affect recommended ventilator settings in AVM in the noncompliant or obstructive lung when minute ventilation (V̇ ) was low. At higher V̇ , AVM compared to ASV recommended a ventilatory strategy with lower V and higher f. These results need to be validated in patients.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.10475