Ventilation for low dissipated energy achieved using flow control during both inspiration and expiration

Barnes, Tom; Enk, Dietmar

doi:10.1016/j.tacc.2018.09.003

Cited by 30 publications

(38 citation statements)

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“…However, the primary idea of FCV is to physically reduce dissipated energy applied to lung tissue as much as possible. The only way to minimize dissipated energy is to keep gas ow constant during the entire ventilation cycle and at the lowest possible level [5,6]. With minimized gas ow, ventilation must be as e cient as possible; therefore, tidal volume was increased within lung mechanic limits to reduce dead space ventilation but simultaneously decrease the risk of atelectasis and/or overdistension (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…However, established calculations for mechanical power applied to the lung tissue consider only the inspiratory effort since expiration is presumed to be a passively occurring process. In earlier work on the concept of FCV we already hypothesized, that energy dissipated in the lung tissue during both inspiration and expiration is an important contributor to VILI [5,6]. In mechanical ventilation, energy is necessarily dissipated because of resistive work that needs to be performed in order to overcome airway and tissue resistance during inspiration as well as expiration.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, P peak was increased stepwise as long as the V T showed a -based on measured dynamic compliance -at least slightly overproportional rise ( Figure 1). Finally, the ow was set to maintain normocapnia at an I:E ratio of 1:1, which is best for minimizing dissipated energy [5,6]. Thus, half of the ow roughly represented the respiratory minute volume (MV) for FCV.…”

Section: Individualization Of Ow-controlled Ventilation (Fcv)mentioning

confidence: 99%

“…Flow-controlled ventilation (FCV) is a ventilation mode in which ow is kept constant during both inspiration and expiration [5,6]. This is a novelty in arti cial ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, ventilation at constant ow (which avoids the high ow peaks as in conventional ventilation) leads to minimization of applied and -more importantly -dissipated energy [5]. There is growing awareness that energy dissipation during the ventilation cycle is related to VILI and thus its reduction seems to be a key factor in developing more protective ventilation strategies [6].…”

Section: Introductionmentioning

confidence: 99%

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Individualized flow-controlled ventilation compared to best clinical practice pressure-controlled ventilation: a prospective randomized porcine study.

Spraider

Martini

Abram

et al. 2020

Preprint

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Background: Flow-controlled ventilation is a novel ventilation method which allows to individualize ventilation according to dynamic lung mechanic limits based on direct tracheal pressure measurement at a stable constant gas flow during inspiration and expiration. The aim of this porcine study was to compare individualized flow-controlled ventilation (FCV) and current guideline-conform pressure-controlled ventilation (PCV) in long-term ventilation.Methods: Anesthetized pigs were ventilated with either FCV or PCV over a period of ten hours with a fixed FiO2 of 0.3. FCV settings were individualized by compliance-guided positive end-expiratory pressure (PEEP) and peak pressure (Ppeak) titration. Flow was adjusted to maintain normocapnia and the inspiration to expiration ratio (I:E ratio) was set at 1:1. PCV was performed with a PEEP of 5 cm H2O and Ppeak was set to achieve a tidal volume (VT) of 7 ml/kg. The respiratory rate was adjusted to maintain normocapnia and the I:E ratio was set at 1:1.5. Repeated measurements during observation period were assessed by linear mixed-effects model.Results: In FCV (n=6) respiratory minute volume was significantly reduced (6.0 vs 12.7, MD -6.8 (-8.2 to -5.4) l/min; p<0.001) as compared to PCV (n=6). Oxygenation was improved in the FCV group (paO2 119.8 vs 96.6, MD 23.2 (9.0 to 37.5) torr; 15.97 vs 12.87, MD 3.10 (1.19 to 5.00) kPa; p=0.010) and CO2 removal was more efficient (paCO2 40.1 vs 44.9, MD -4.7 (-7.4 to -2.0) torr; 5.35 vs 5.98, MD -0.63 (-0.99 to -0.27) kPa; p=0.006). Ppeak and driving pressure were comparable in both groups, whereas PEEP was significantly lower in FCV (p=0.002). Computed tomography revealed a significant reduction in non-aerated lung tissue in individualized FCV (p=0.026) and no significant difference in overdistended lung tissue, although a significantly higher VT was applied (8.2 vs 7.6, MD 0.7 (0.2 to 1.2) ml/kg; p=0.025).Conclusion: Our long-term ventilation study demonstrates the applicability of a compliance-guided individualization of FCV settings, which resulted in significantly improved gas exchange and lung tissue aeration without signs of overinflation as compared to best clinical practice PCV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Individualization Of Ow-controlled Ventilation (Fcv)mentioning

confidence: 99%

“…Flow-controlled ventilation (FCV) is a ventilation mode in which ow is kept constant during both inspiration and expiration [5,6]. This is a novelty in arti cial ventilation.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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