From state-of-the-art ventilation to closed loop ventilation

Abstract

Recent emphasis on energy load delivered during each ventilatory breath has opened a new insight to reduce harmful ventilatory induced lung injury, but no robust clinical evidence of patient benefit produced yet. Closed loop ventilation is a strategy to adjust respiratory support using physiological feedback data obtained for each delivered cycle of respiratory support. Dependent on the model assumption used, closed loop ventilation aims to identify the ideal combination of tidal volume size, reduced driving pressure or respiratory frequency ultimately reducing the energy loading of the lung. This review aims to discuss the current state-of-the-art ventilation concepts and their integration in closed loop ventilation.

Alveolar mechanics: A new concept in respiratory monitoring

“…In the injured lung however, cyclic closure and reopening of alveoli can occur, and hence the convection-diffusion front has moved from the peripheral airways into the alveolar space. 23,24,25 In an animal study, Gil and colleagues 26 surface. Another animal study of injured lungs by Mertens and colleagues 27 found out that alveolar cycling was not observed according to the concept of alveolar stability.…”

“…Adaptive Ventilation Mode-2 (AVM-2) is a closed loop mode of ventilation with an optimal targeting scheme using the concept of mean inspiratory power (sum of the resistive and tidal power) that takes the VD into account in its algorithm for targeting the optimal VT and respiratory rate. 39,40 -Alveolar resistance…”

The Rise of the Machines: Why the future lies with less injurious adaptive ventilation strategies

“…8,11 Schibler's review of adaptive ventilation provides an excellent overview of the damaging, but potentially avoidable ventilator induced lung injury (VILI). 12 The three potential malfeasants -VT, DP and "power of ventilation" can all potentially be addressed using an adaptive mode. Mechanical power was associated with mortality in some patients' groups with ARDS but the influences of alteration in flow patterns, power spikes and positive end expiratory pressure (PEEP) are less clear.…”

“…Mechanical power was associated with mortality in some patients' groups with ARDS but the influences of alteration in flow patterns, power spikes and positive end expiratory pressure (PEEP) are less clear. 10,12 Nevertheless, the dynamic nature changes in compliance resistance, and operator-imposed changes are all potential hazards.…”