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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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Monitoring of arterial carbon dioxide tension and end-tidal carbon dioxide during automatic ventilation therapy using ARDSNet protocol for the 27 kg pig. ABG, arterial blood gas; ARDSNet, Acute Respiratory Distress Syndrome Network; etCO2, end-tidal carbon dioxide; PaCO2, arterial carbon dioxide tension.
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Figure 5: Monitoring of arterial carbon dioxide tension and end-tidal carbon dioxide during automatic ventilation therapy using ARDSNet protocol for the 27 kg pig. ABG, arterial blood gas; ARDSNet, Acute Respiratory Distress Syndrome Network; etCO2, end-tidal carbon dioxide; PaCO2, arterial carbon dioxide tension.

Mentions: Figure 5 shows arterial carbon dioxide tension (PaCO2) from ABG and end-tidal carbon dioxide (etCO2) during the 4 hours of ventilation. PaCO2 significantly increased after lung lavage, which indicates poor gas exchange or partial lung collapse (atelectasis). This is also confirmed by the SaO2 curve and the EIT images in the next subsection. After turning on the protocol for 2 hours during 0.5 to 2.5 hours, gas exchange was gradually improved due to the ventilation therapy. Again, at 2.5 hours, poor gas exchange recurred during hypoxia because of disconnection at the patient–ventilator interface for 10 seconds. Since PaCO2 was taken before disconnection at the patient–ventilator interface, severe hypercapnia was later detected (at 3 hours). However, the automatic ventilation improved gas exchange and severe hypercapnia was relieved in a timely manner.


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)

Monitoring of arterial carbon dioxide tension and end-tidal carbon dioxide during automatic ventilation therapy using ARDSNet protocol for the 27 kg pig. ABG, arterial blood gas; ARDSNet, Acute Respiratory Distress Syndrome Network; etCO2, end-tidal carbon dioxide; PaCO2, arterial carbon dioxide tension.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Monitoring of arterial carbon dioxide tension and end-tidal carbon dioxide during automatic ventilation therapy using ARDSNet protocol for the 27 kg pig. ABG, arterial blood gas; ARDSNet, Acute Respiratory Distress Syndrome Network; etCO2, end-tidal carbon dioxide; PaCO2, arterial carbon dioxide tension.
Mentions: Figure 5 shows arterial carbon dioxide tension (PaCO2) from ABG and end-tidal carbon dioxide (etCO2) during the 4 hours of ventilation. PaCO2 significantly increased after lung lavage, which indicates poor gas exchange or partial lung collapse (atelectasis). This is also confirmed by the SaO2 curve and the EIT images in the next subsection. After turning on the protocol for 2 hours during 0.5 to 2.5 hours, gas exchange was gradually improved due to the ventilation therapy. Again, at 2.5 hours, poor gas exchange recurred during hypoxia because of disconnection at the patient–ventilator interface for 10 seconds. Since PaCO2 was taken before disconnection at the patient–ventilator interface, severe hypercapnia was later detected (at 3 hours). However, the automatic ventilation improved gas exchange and severe hypercapnia was relieved in a timely manner.

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