![Dr Jean-Michel Arnal Intensive Care Unit. Hôpital Font Pré Toulon France [email_address] Close loop ventilation in the ICU](https://image.slidesharecdn.com/closeloopventilation-110428090432-phpapp01/85/Close-loop-Ventilation-1-320.jpg)
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Close loop Ventilation
- 1. Dr Jean-Michel Arnal Intensive Care Unit. Hôpital Font Pré Toulon France [email_address] Close loop ventilation in the ICU
- 5. Positive close loop control C ontroller = i’ x i Valves Signal: Flow= i’ Gain = i P insp Unstable Add complexity Act as auxiliary respiratory muscle Intrabreath
- 6. Negative close loop control C ontroller = i– i’ Valves Signal: V T actual = i’ V T Target = i P insp Target can be achieved Fast response Adapts to external modifications Interbreath
- 7. Determination of the target C ontroller = i– i’ Valves Signal: V T actual = i’ V T Target = i P insp Operator set Automatically determined
- 12. Commercially available solutions Controlled mode Assisted mode Spont mode PAV NAVA SmartCare Adaptive Support Ventilation IntelliVent®
- 15. Improve patient ventilator synchrony Terzi. Crit Care Med 2010 n = 11
- 16. Increase variability of ventilation Coizel. Anesthesiology 2010 n = 12 n = 12 Schmidt. Anesthesiology 2010
- 18. Decreases weaning duration Lellouche. AJRCCM 2006 n = 144 patients, ventilation > 24 h
- 19. SmartCare n = 102 Rose. Intensive Care Med 2008 Weaning success: Control: 40 h (14 – 87) Smartcare: 43 h (6 – 169)
- 20. Adaptive Support Ventilation Ventilation Oxygenation Conventional ventilation ASV MV V T RR FiO 2 PEEP MV V T RR FiO 2 PEEP
- 21. Background The optimal respiratory rate 0.16 0.14 0.12 0.10 0.08 0.06 0.04 0.02 0 0 10 20 30 40 50 WOB res WOB el WOB tot 1+2a* RCe *( VM -f*( V‘D/VD )) - 1 f -target = a* RCe Respiratory rate (cycle/mn) WOB (Joule/sec) Otis AB.J Appl Physiol 1950
- 23. Ventilation delivered * p ≤ 0,05 versus normal Arnal. Intensive Care Med 2008 Normal COPD Chest wall stiffness ARDS n (d/patients) 706 / 140 217 / 40 54 / 13 136 / 36 RC exp (s) 0,78 ± 0,28 1,13 0,72* 0,41 0,16* 0,55 ± 0,21 * Vt/PBW (ml/Kg) 8,3 1,3 9,4 2,1* 7,1 1,1* 7,6 1,3 * RR (c/mn) 17 5 16 7 23 7* 20 6 * I/E 0,5 0,2 0,4 0,2* 0,5 0,2 0,63 0,27 *
- 24. Ventilation delivered Arnal. Intensive Care Med 2008
- 26. ASV and weaning Results: MV duration (h) n Control ASV p Sultzer Anesthesiology 2001 36 4,0 3,2 p < 0,02 Petter Anesth Analg 2003 34 3,2 2,7 NS Gruber Anesthesiology 2008 48 8,0 2,7 P < 0,05 Dongelmans Anesth Analg 2009 121 16,3 16,2 NS
- 27. ASV and weaning in COPD Kirakli. Eur Respir J 2011 n = 97
- 29. IntelliVent Ventilation Oxygenation Conventional ventilation ASV IntelliVent ® MV V T RR FiO 2 PEEP MV V T RR FiO 2 PEEP MV V T RR FiO 2 PEEP
- 30. IntelliVent
- 31. IntelliVent
Hinweis der Redaktion
- This study from Australia compared Smartcare with usual weaning in a single unit with a 1/1 nurse patient ratio, with very high qualified nurses. The result didn’t show any difference between control and Smartcare. At least, smartcare works as good as best practice in protocols.
- This physiologic figure is the background of ASV. It shows that for a given minute ventilation, there is an optimal respiratory rate that is associated with the minimal work or breathing. Otis showed in the fifty’s that this optimal respiratory rate depends on minute ventilation, dead space and expiratory time constant. Expiratory time constant resume the mechanical characteristics of the respiratory system because it is the product of resistances and compliance.