Top

Intensive Care Medicine

Published in:

01-04-2013 | Original

Adaptive support ventilation with and without end-tidal CO₂ closed loop control versus conventional ventilation

Authors: Demet S. Sulemanji, Andrew Marchese, Marc Wysocki, Robert M. Kacmarek

Published in: Intensive Care Medicine | Issue 4/2013

Abstract

Purpose

Our aim was to compare adaptive support ventilation with and without closed loop control by end tidal CO₂ (ASVCO₂, ASV) with pressure (PC) and volume control ventilation (VC) during simulated clinical scenarios [normal lungs (N), COPD, ARDS, brain injury (BI)].

Methods

A lung model was used to simulate representative compliance (mL/cmH₂O): resistance (cmH₂O/L/s) combinations, 45:5 for N and BI, 60:7.7 for COPD, 15:7.7 and 35:7.7 for ARDS. Two levels of PEEP (cmH₂O) were used for each scenario, 12/16 for ARDS, and 5/10 for others. The CO₂ productions of 2, 3, 4 and 5 mL/kg predicted body weight/min were simulated. Tidal volume was set to 6 mL/kg during VC and PC. Outcomes of interest were end tidal CO₂ (etCO₂) and plateau pressure (P _Plat).

Results

EtCO₂ levels in N and BI and COPD were similar for all modes. In ARDS, etCO₂ was higher in ASVCO₂ than in other modes (p < 0.001). Under all mechanical conditions ASVCO₂ revealed a narrower range of etCO₂. P _Plat was similar for all modes in all scenarios but ARDS where P _Plat in ASV and ASVCO₂ were lower than in VC (p = 0.001). When P _Plat was ≥28 cmH₂O, P _plat in ASV and ASVCO₂ were lower than in VC and PC (p = 0.024).

Conclusion

All modes performed similarly in most cases. Minor differences observed were in favor of the closed loop modes. Overall, ASVCO₂ maintained tighter CO₂ control. The ASVCO₂ had the greatest impact during ARDS allowing etCO₂ to increase and protecting against hypocapnia evident with other modes while ensuring lower P _plat and tidal volumes.

Available only for authorised users

Otis AB (1954) The work of breathing. Physiol Rev 34:449–458PubMed

Thompson BT, Hayden D, Matthay MA, Brower R, Parsons PE (2001) Clinicians’ approaches to mechanical ventilation in acute lung injury and ARDS. Chest 120:1622–1627PubMedCrossRef

Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM (2009) Adaptive support ventilation; an appropriate mechanical ventilation strategy for the acute respiratory distress syndrome? Anesthesiology 111:863–870PubMedCrossRef

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med 342:1301–1308CrossRef

Johannigman JA, Muskat P, Barnes S, Davis K, Branson RD (2008) Autonomous control of ventilation. J Trauma 64:S302–S320PubMedCrossRef

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective ventilation strategy on mortality in the acute respiratory distress syndrome. N Eng J Med 338:347–354CrossRef

Bernasconi M, Ploysongsang Y, Gottfried SB, Milc-Emily C, Rossi A (1998) Respiratory compliance and resistance in mechanically ventilated patients with acute respiratory failure. Intensive Care Med 14:547–553CrossRef

Kallet RH, Hemphill J, Dicker RA, Alonso JA, Campbell AR, MacKersie RC, Katz JA (2007) The spontaneous breathing pattern and work of breathing of patients with acute respiratory distress syndrome and acute lung injury. Resp Care 52:989–995

Nunes S, Balta P, Takala J (2006) Changes in respiratory mechanics and gas exchange during the acute respiratory distress syndrome. Acta Anesthesiol Scand 50:80–91CrossRef

10.

Yang SC, Yang SP (2002) Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation. Chest 122:2096–2104PubMedCrossRef

11.

Tsukino M, Nishimura K, Ikeda A, Koyama H, Mishima M, Izumi T (1996) Physiologic factors that determine the health related quality of life in patients with COPD. Chest 110:896–903PubMedCrossRef

12.

Hamilton Medical AG (2009) Detail specifications ventilation controller, Switzerland, Doc No: E40015, version: 1.16: 7–14

13.

Arnal JM, Wysocki M, Nafati C, Donati S, Granier I, Corno G, Durand-Gasselin J (2008) Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 34:75–81PubMedCrossRef

14.

Cassina T, Chiolero R, Mauri R, Revelly JP (2003) Clinical experience with adaptive support ventilation for fast-track cardiac surgery. J Cardiothorac Vasc Anesth 17:571–575PubMedCrossRef

15.

Veelo DP, Dongelmans DA, Binnekade JM, Paulus F, Schultz MJ (2010) Adaptive support ventilation: evaluating the size of delivered tidal volumes. Int J Artif Organs 33:302–309PubMed

16.

Iotti GA, Polito A, Belliato M, Pasero D, Beduneanu G, Wysocki M, Brunner J, Braschi A, Brochard L, Mancebo J, Ranieri VM, Richard JC, Slutsky AS (2010) Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med 36:1371–1379PubMedCrossRef

17.

Hickling KG, Walsh J, Henderson S, Jackson R (1994) Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med 22:1568–1578PubMedCrossRef

18.

Bidani A, Tzouanakis AE, Cardenas VJ Jr, Zwischenberger JB (1994) Permissive hypercapnia in acute respiratory failure. JAMA 272:957–962PubMedCrossRef

19.

Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med 34:17–60PubMedCrossRef

20.

Laffey JG, Honan D, Hopkins N, Hyvelin JM, Boylan JF, McLoughlin P (2004) Hypercapnic acidosis attenuates endotoxin-induced acute lung injury. Am J Respir Crit Care Med 169:46–56PubMedCrossRef

21.

Suarez-Sipmann F, Bohm SH, Tusman G, Pesch T, Thamm O, Reismann H, Reske A, Magnusson A, Hedenstierna G (2007) Use of dynamic compliance for open lung positive end expiratory pressure titration in an experimental study. Crit Care Med 35:214–221PubMedCrossRef

22.

Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18:139–141PubMedCrossRef

23.

Kacmarek RM, Villar J (2011) When it comes to ventilation noisy is better than quiet and variability is healthier than constant! Crit Care Med 39:898–899PubMedCrossRef

Title: Adaptive support ventilation with and without end-tidal CO2 closed loop control versus conventional ventilation
Authors: Demet S. Sulemanji
Andrew Marchese
Marc Wysocki
Robert M. Kacmarek
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2742-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adaptive support ventilation with and without end-tidal CO₂ closed loop control versus conventional ventilation

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2013

Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units

Recombinant human soluble thrombomodulin in sepsis-induced disseminated intravascular coagulation: a multicenter propensity score analysis

Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy

Erratum to: Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study

Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy

Tissue Doppler imaging, volume responsiveness and impaired relaxation: reply to comment by Wiersema