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Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography.

Pomprapa A, Schwaiberger D, Pickerodt P, Tjarks O, Lachmann B, Leonhardt S - Crit Care (2014)

Bottom Line: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy.However, the automated protocol-driven ventilation was able to solve these problems.Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.

Methods: A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.

Results: This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.

Conclusions: We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects.

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Control of arterial oxygen saturation using Table1for a 27 kg pig. Right: magnified view for 15 minutes after the disconnection time (2.5 hours). ARDSNet, Acute Respiratory Distress Syndrome Network; FiO2, fraction of inspired oxygen; SaO2, arterial oxygen saturation; PEEP, positive end-expiratory pressure; VTPW, tidal volume per weight.
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Figure 2: Control of arterial oxygen saturation using Table1for a 27 kg pig. Right: magnified view for 15 minutes after the disconnection time (2.5 hours). ARDSNet, Acute Respiratory Distress Syndrome Network; FiO2, fraction of inspired oxygen; SaO2, arterial oxygen saturation; PEEP, positive end-expiratory pressure; VTPW, tidal volume per weight.

Mentions: Figure 2 shows the response of lung lavage in the first 30 minutes and the automatic ventilation for stabilization and regulation of SaO2 by adjusting PEEP and FiO2 referred to in Table 1. At 2.5 hours, or 2 hours after automatic ventilation, a disconnection of ventilation was made for 10 seconds, simulating a clinical scenario of airway suction or accidental disconnection. The controller was able to recover the critical situation of low oxygenation by step-by-step change for the values of PEEP and FiO2, until PEEP of 24 cmH2O and FiO2 of 1.0. Subsequently, an automatic titration of suitable PEEP and FiO2 was carried out again to fulfill the oxygenation goal.


Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography.

Pomprapa A, Schwaiberger D, Pickerodt P, Tjarks O, Lachmann B, Leonhardt S - Crit Care (2014)

Control of arterial oxygen saturation using Table1for a 27 kg pig. Right: magnified view for 15 minutes after the disconnection time (2.5 hours). ARDSNet, Acute Respiratory Distress Syndrome Network; FiO2, fraction of inspired oxygen; SaO2, arterial oxygen saturation; PEEP, positive end-expiratory pressure; VTPW, tidal volume per weight.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230798&req=5

Figure 2: Control of arterial oxygen saturation using Table1for a 27 kg pig. Right: magnified view for 15 minutes after the disconnection time (2.5 hours). ARDSNet, Acute Respiratory Distress Syndrome Network; FiO2, fraction of inspired oxygen; SaO2, arterial oxygen saturation; PEEP, positive end-expiratory pressure; VTPW, tidal volume per weight.
Mentions: Figure 2 shows the response of lung lavage in the first 30 minutes and the automatic ventilation for stabilization and regulation of SaO2 by adjusting PEEP and FiO2 referred to in Table 1. At 2.5 hours, or 2 hours after automatic ventilation, a disconnection of ventilation was made for 10 seconds, simulating a clinical scenario of airway suction or accidental disconnection. The controller was able to recover the critical situation of low oxygenation by step-by-step change for the values of PEEP and FiO2, until PEEP of 24 cmH2O and FiO2 of 1.0. Subsequently, an automatic titration of suitable PEEP and FiO2 was carried out again to fulfill the oxygenation goal.

Bottom Line: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy.However, the automated protocol-driven ventilation was able to solve these problems.Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.

Methods: A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.

Results: This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.

Conclusions: We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects.

Show MeSH
Related in: MedlinePlus