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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.

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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 plateau pressure with the computed lung compliance for the 27 kg pig. ARDSNet, Acute Respiratory Distress Syndrome Network; Crs, lung compliance; PEEP, positive end-expiratory pressure; Pplat, plateau pressure; VTPW, tidal volume per weight.
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Figure 3: Control of plateau pressure with the computed lung compliance for the 27 kg pig. ARDSNet, Acute Respiratory Distress Syndrome Network; Crs, lung compliance; PEEP, positive end-expiratory pressure; Pplat, plateau pressure; VTPW, tidal volume per weight.

Mentions: To minimize ventilator-induced lung injury, the Pplat goal should be kept below 30 cmH2O by the adjustment of VT[13]. During the time 0.5 to 2.5 hours shown in Figure 3, Pplat was definitely less than 25 cmH2O while VTPW was maintained at 6 ml/kg.


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 plateau pressure with the computed lung compliance for the 27 kg pig. ARDSNet, Acute Respiratory Distress Syndrome Network; Crs, lung compliance; PEEP, positive end-expiratory pressure; Pplat, plateau 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 3: Control of plateau pressure with the computed lung compliance for the 27 kg pig. ARDSNet, Acute Respiratory Distress Syndrome Network; Crs, lung compliance; PEEP, positive end-expiratory pressure; Pplat, plateau pressure; VTPW, tidal volume per weight.
Mentions: To minimize ventilator-induced lung injury, the Pplat goal should be kept below 30 cmH2O by the adjustment of VT[13]. During the time 0.5 to 2.5 hours shown in Figure 3, Pplat was definitely less than 25 cmH2O while VTPW was maintained at 6 ml/kg.

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