바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.70 No.1
Citation Share

Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2011, v.70 no.1, pp.36-42







& (2011). Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation. Tuberculosis & Respiratory Diseases, 70(1), 36-42.
  • Downloaded
  • Viewed
PDF Download

Abstract

Background: Adaptive support ventilation (ASV), an automated closed-loop ventilation mode, adapts to the mechanical characteristics of the respiratory system by continuous measurement and adjustment of the respiratory parameters. The adequacy of ASV was evaluated in the patients with acute lung injury (ALI). Methods: A total of 36 patients (19 normal lungs and 17 ALIs) were enrolled. The patients' breathing patterns and respiratory mechanics parameters were recorded under the passive ventilation using the ASV mode. Results: The ALI patients showed lower tidal volumes and higher respiratory rates (RR) compared to patients with normal lungs (7.1±0.9 mL/kg vs. 8.6±1.3 mL/kg IBW; 19.7±4.8 b/min vs. 14.6±4.6 b/min; p＜0.05, respectively). The expiratory time constant (RCe) was lower in ALI patients than in those with normal lungs, and the expiratory time/RCe was maintained above 3 in both groups. In all patients, RR was correlated with RCe and peak inspiratory flow (r_s=−0.40; r_s=0.43; p＜0.05, respectively). In ALI patients, significant correlations were found between RR and RCe (r_s=−0.76, p＜0.01), peak inspiratory flow and RR (r_s=−0.53, p＜0.05), and RCe and peak inspiratory flow (r_s=−0.53, p＜0.05). Conclusion: ASV was found to operate adequately according to the respiratory mechanical characteristics in the ALI patients. Discrepancies with the ARDS Network recommendations, such as a somewhat higher tidal volume, have yet to be addressed in further studies.

keywords
Acute Lung Injury, Respiratory Mechanics, Ventilators, Mechanical, Automation, Ventilator-Induced Lung Injury, Acute Lung Injury, Respiratory Mechanics, Ventilators, Mechanical, Automation, Ventilator-Induced Lung Injury

Reference

1.

1. Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol 1950;2:592-607.

2.

2. Brunner JX, Iotti GA. Adaptive support ventilation (ASV). Minerva Anestesiol 2002;68:365-8.

3.

3. Campbell RS, Branson RD, Johannigman JA. Adaptive support ventilation. Respir Care Clin N Am 2001;7: 425-40.

4.

4. Laubscher TP, Frutiger A, Fanconi S, Jutzi H, Brunner JX. Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as start up procedure for closed-loop controlled ventilation. Int J Clin Monit Comput 1994;11:19-30.

5.

5. Arnal JM, Wysocki M, Nafati C, Donati S, Granier I, Corno G, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 2008;34:75-81.

6.

6. Iotti GA, Polito A, Belliato M, Pasero D, Beduneau G, Wysocki M, et al. Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med 2010;36: 1371-9.

7.

7. Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg 2003;97:1743-50.

8.

8. Burns KE, Lellouche F, Lessard MR. Automating the weaning process with advanced closed-loop systems. Intensive Care Med 2008;34:1757-65.

9.

9. Linton DM, Potgieter PD, Davis S, Fourie AT, Brunner JX, Laubscher TP. Automatic weaning from mechanical ventilation using an adaptive lung ventilation controller. Chest 1994;106:1843-50.

10.

10. Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM. Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome? Anesthesiology 2009;111:863- 70.

11.

11. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.

12.

12. Dongelmans DA, Schultz MJ. Adaptive support ventilation: an inappropriate mechanical ventilation strategy for acute respiratory distress syndrome? Anesthesiology 2010;112:1295; author reply 1295-6.

13.

13. Choi IS, Koh YS, Leem CM, Choi JE, Hong SB. A comparison of adaptive support ventilation (ASV) and conventional volume-controlled ventilation on respiratory mechanics in acute lung injury/ARDS. Korean J Crit Care Med 2009;24:59-63.

14.

14. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. J Crit Care 1994;9:72-81.

15.

15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.

16.

16. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754-8.

17.

17. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm 1974;8:650-5.

18.

18. Slutsky AS. Consensus conference on mechanical ventilation-- January 28-30, 1993 at Northbrook, Illinois, USA. Part 2. Intensive Care Med 1994;20:150-62.

19.

19. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974;2:656-9.

20.

20. Iotti GA, Braschi A, Brunner JX, Smits T, Olivei M, Palo A, et al. Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med 1995;21:406-13.

21.

21. Kallet RH, Jasmer RM, Pittet JF, Tang JF, Campbell AR, Dicker R, et al. Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls. Crit Care Med 2005;33:925-9.

22.

22. Hager DN, Krishnan JA, Hayden DL, Brower RG; ARDS Clinical Trials Network. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 2005;172: 1241-5.

23.

23. Gattinoni L, Vagginelli F, Chiumello D, Taccone P, Carlesso E. Physiologic rationale for ventilator setting in acute lung injury/acute respiratory distress syndrome patients. Crit Care Med 2003;31:S300-4.

24.

24. Marini JJ, Gattinoni L. Ventilatory management of acute respiratory distress syndrome: a consensus of two. Crit Care Med 2004;32:250-5.

25.

25. Gattinoni L, Pesenti A. The concept of "baby lung". Intensive Care Med 2005;31:776-84.

26.

26. Kacmarek RM. Lung protection: the cost in some is increased work of breathing. Is it too high? Respir Care 2005;50:1614-6.

27.

27. Deans KJ, Minneci PC, Cui X, Banks SM, Natanson C, Eichacker PQ. Mechanical ventilation in ARDS: one size does not fit all. Crit Care Med 2005;33:1141-3.

28.

28. Jardin F. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 2006;173:685-6; author reply 687.

29.

29. Amato MB, Barbas CS, Medeiros DM, Schettino Gde P, Lorenzi Filho G, Kairalla RA, et al. Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med 1995;152:1835-46.

30.

30. Weiler N, Eberle B, Heinrichs W. Adaptive lung ventilation (ALV) during anesthesia for pulmonary surgery: automatic response to transitions to and from one-lung ventilation. J Clin Monit Comput 1998;14:245-52.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy