Closed-Loop Control of Mechanical Ventilation: Description and Classification of Targeting Schemes

Chatburn, Robert L; Mireles-Cabodevila, Eduardo

doi:10.4187/respcare.00967

Cited by 112 publications

(67 citation statements)

References 45 publications

(41 reference statements)

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“…In addition to the modes already discussed in this summary, the clinician can now choose from AutoMode, mandatory rate ventilation, pressure-controlled synchronized mandatory ventilation, proportional pressure support, and SmartCare-among many others. As pointed out by Rob Chatburn in his presentation on the classification of ventilator targeting schemes, 8 one current respiratory equipment book lists 56 unique mode names, as compared to 3 in a comparable book from 1973. As a clinician and educator, although I used to understand generally how ventilators worked, faced with this overwhelming complexity I no longer do-and this is a big problem when it comes to understanding and optimizing PVI.…”

Section: Conceptualizing and Assessing Ventilator Modes With Respect mentioning

confidence: 99%

“…This paper summarizes what I took to be the most important messages of the individual presentations and the discussions that followed them, and offers some of my own observations on this central component of the management of patients with acute respiratory failure. With a few exceptions I will not attempt to cite the most important primary work that has been done in this field; the individual papers in these 2 special issues [1][2][3][4][5][6][7][8][9][10][11][12][13][14] provide a comprehensive and authoritative review of the literature pertaining to PVI.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Ventilator Interaction

Pierson

2011

Respir Care

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SummaryPatient-ventilator interaction has been the focus of increasing attention from both manufacturers and researchers during the last 25 years. There is now compelling evidence that passive (controlled) mechanical ventilation leads to respiratory muscle dysfunction and atrophy, prolonging the need for ventilatory support and predisposing to a number of adverse patient outcomes. Although there is consensus that the respiratory muscles should retain some activity during acute respiratory failure, patient-ventilator asynchrony is now recognized as a cause of ineffective ventilation, impaired gas exchange, lung overdistention, increased work of breathing, and patient discomfort. Far more common than previously recognized, it also predisposes to respiratory muscle dysfunction and other complications, leads to excessive use of sedation, increases the duration of ventilatory support, and interferes with weaning. Appropriate recognition and management of patient-ventilator asynchrony require bedside assessment of ventilator graphics as well as direct patient observation. Among currently available ventilation modes and approaches, none has been shown to be clearly superior to all the others with respect to patient-ventilator interaction, and strongly held prefer- 214RESPIRATORY CARE • FEBRUARY 2011 VOL 56 NO 2 ences among investigators have led to controversy and difficulties in carrying out appropriate studies evaluating them. As a result, marked practice variation exists among different specialties as well as in different institutions and geographical areas. The respected authorities on mechanical ventilation who participated in this conference differed in the modes they preferred but agreed that proper understanding and use according to the individual patient's needs are more important than which mode is chosen. Conference participants discussed the determinants, manifestations, and epidemiology of patient-ventilator asynchrony, and described and compared several ventilation modes aimed specifically at preventing and ameliorating it. The papers arising from these discussions represent the most thorough examination of this important aspect of respiratory care yet published.

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Section: Conceptualizing and Assessing Ventilator Modes With Respect mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-Ventilator Interaction

Pierson

2011

Respir Care

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“…Having written ventilator-related content in such textbooks, we can safely say that such material was never designed to be used as the basis for a class syllabus. In most of our previous writings focusing on modes of mechanical ventilation, 7,14,25,26 the emphasis has been on descriptions of modes rather than the background technical knowledge required to understand them. That knowledge was assumed on the part of the reader (and instructor).…”

Section: The Problem Of Teaching Mechanical Ventilationmentioning

confidence: 99%

“…Some ventilators will add the difference to the next mandatory period to maintain the set mandatory breathing frequency (eg, Dräger Evita XL ventilator). 14 of the relationship between operator inputs and ventilator outputs to achieve a specific ventilatory pattern, usually in the form of a feedback control system. A target is a predetermined goal of ventilator output.…”

Section: The 10 Maximsmentioning

confidence: 99%

A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims

2014

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The American Association for Respiratory Care has declared a benchmark for competency in mechanical ventilation that includes the ability to "apply to practice all ventilation modes currently available on all invasive and noninvasive mechanical ventilators." This level of competency presupposes the ability to identify, classify, compare, and contrast all modes of ventilation. Unfortunately, current educational paradigms do not supply the tools to achieve such goals. To fill this gap, we expand and refine a previously described taxonomy for classifying modes of ventilation and explain how it can be understood in terms of 10 fundamental constructs of ventilator technology: (1) defining a breath, (2) defining an assisted breath, (3) specifying the means of assisting breaths based on control variables specified by the equation of motion, (4) classifying breaths in terms of how inspiration is started and stopped, (5) identifying ventilator-initiated versus patient-initiated start and stop events, (6) defining spontaneous and mandatory breaths, (7) defining breath sequences (8), combining control variables and breath sequences into ventilatory patterns, (9) describing targeting schemes, and (10) constructing a formal taxonomy for modes of ventilation composed of control variable, breath sequence, and targeting schemes. Having established the theoretical basis of the taxonomy, we demonstrate a step-by-step procedure to classify any mode on any mechanical ventilator.

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“…Due to growing evidence of NIV's effectiveness in a broad range of indications and increasing availability of user-friendly portable devices, the number of patients receiving NIV at home is continuously increasing, For example, NIV is increasingly applied in different settings, such as critical care units, pulmonary, cardiology 3 or neurological 4 departments, pediatrics facilities, weaning centers, sleep labs, in the emergency room, 5,6 in pre-hospital care, 7 and in general wards. 8 As a "victim of its own success" NIV has become a generalized practice, and it is not unusual that it may be carried out by nonspecialized healthcare professionals.…”

mentioning

confidence: 99%