The dawn of physiological closed-loop ventilation—a review

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Abstract

The level of automation in mechanical ventilation has been steadily increasing over the last few decades. There has recently been renewed interest in physiological closed-loop control of ventilation. The development of these systems has followed a similar path to that of manual clinical ventilation, starting with ensuring optimal gas exchange and shifting to the prevention of ventilator-induced lung injury. Systems currently aim to encompass both aspects, and early commercial systems are appearing. These developments remain unknown to many clinicians and, hence, limit their adoption into the clinical environment. This review shows the evolution of the physiological closed-loop control of mechanical ventilation.

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The relation between inspiratory effort and ventilatory return (flow and volume) is usually abnormal in patients who require ventilatory support because of respiratory distress. Although all available support methods provide the patient with greater ventilation than would obtain with the same effort while unsupported, the relation between instantaneous effort and ventilatory consequences is not normalized. We describe an approach with which the ventilator simply amplifies patient instantaneous effort throughout inspiration while leaving the patient with complete control over all aspects of breathing pattern (tidal volume, inspiratory and expiratory durations, and flow patterns). This approach is implemented by monitoring the instantaneous rate (V) and volume (V) of gas flow from ventilator to patient and causing applied pressure (P) to change according to the equation of motion [P = f1(V) + f2(V)], where f1 and f2 are appropriately selected functions for the relation between pressure and volume (elastic assist) and pressure and flow (resistive assist). There are several potential advantages to this approach: (1) greater comfort; (2) reduction of peak airway pressure required to sustain ventilation and, hence, the potential for avoiding intubation; (3) less likelihood of overventilation; (4) preservation and enhancement of patient's own reflex, behavioral, and homeostatic control mechanisms since the ventilator essentially becomes an extension of the patient's own muscles; and (5) improved efficiency of negative pressure ventilation.

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Author and article information

Contributors

Philip von Platen:

ORCID: http://orcid.org/0000-0003-3357-1451

platen@hia.rwth-aachen.de

Anake Pomprapa: pomprapa@hia.rwth-aachen.de

Burkhard Lachmann: burkhard.lachmann@gmail.com

Steffen Leonhardt: leonhardt@hia.rwth-aachen.de

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 29 March 2020

Publication date PMC-release: 29 March 2020

Publication date Collection: 2020

Volume: 24

Electronic Location Identifier: 121

Affiliations

[1 ]GRID grid.1957.a, ISNI 0000 0001 0728 696X, Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, ; Pauwelsstr. 20, Aachen, 52074 Germany

[2 ]Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353 Germany

Author information

Philip von Platen http://orcid.org/0000-0003-3357-1451

Article

Publisher ID: 2810

DOI: 10.1186/s13054-020-2810-1

PMC ID: 7104522

PubMed ID: 32223754

SO-VID: 85c5a544-8d12-431c-a56a-bfadc748d443

License:

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