scholarly journals Patient-Ventilator Interaction Testing Using the Electro- mechanical Lung Simulator xPULM™during V/A-C and PSV Ventilation Mode

2021 ◽  
Author(s):  
Richard Pasteka ◽  
Joao Pedro Santos da Costa ◽  
Nelson Barros ◽  
Radim Kolar ◽  
Mathias Forjan
Keyword(s):  
Spontaneous Breathing ◽  
Peak Inspiratory Pressure ◽  
Mechanical Ventilator ◽  
Mechanical Lung ◽  
Lung Simulator ◽  
Alternative Approach ◽  
Ventilation Modes ◽  
Interaction Testing ◽  
Ventilator Performance ◽  
Major Increase

During mechanical ventilation, a disparity between flow, pressure or volume demands of the patient and the assistance delivered by the mechanical ventilator often occurs. Asynchrony effect and ventilator performance are frequently studied from ICU datasets or using commercially available lung simulators and test lungs. This paper introduces an alternative approach of simulating and evaluating patient-ventilator interactions with high fidelity using the electro-mechanical lung simulator xPULM™ under selected conditions. The xPULM™ approximates respiratory activities of a patient during alternating phases of spontaneous breathing and apnoea intervals while connected to a mechanical ventilator. Focusing on different triggering events, volume assist-controlled (V/A-C) and pressure support ventilation (PSV) modes were chosen to test patient-ventilator interactions. In V/A-C mode a double-triggering was detected every third breathing cycle leading to an asynchrony index of 16.67%, being classified as severe. This asynchrony causes a major increase of Peak Inspiratory Pressure PIP = 12.80 ± 1.39 cmH2O and Peak Expiratory Flow PEF = -18.33 ± 1.13 L/min when compared to synchronous phases of the breathing simulation. Additionally, events of premature cycling were observed during PSV mode. In this mode, the peak delivered volume during simulated spontaneous breathing phases almost doubles compared to apnoea phases. The presented approach demonstrates the possibility of simulating and evaluating disparities in fundamental ventilation characteristics caused by double-triggering and premature cycling under V/A-C and PSV ventilation modes. Various dynamic clinical situations can be approximated and could help to identify undesired patient-ventilation interactions in the future. Rapidly manufactured ventilator systems could also be tested using this approach.

scholarly journals Patient–Ventilator Interaction Testing Using the Electromechanical Lung Simulator xPULM™ during V/A-C and PSV Ventilation Mode

2021 ◽  
Vol 11 (9) ◽  
pp. 3745
Author(s):  
Richard Pasteka ◽  
Joao Pedro Santos da Costa ◽  
Nelson Barros ◽  
Radim Kolar ◽  
Mathias Forjan
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Peak Inspiratory Pressure ◽  
Mechanical Ventilator ◽  
Lung Simulator ◽  
Alternative Approach ◽  
Interaction Testing ◽  
Flow Pressure ◽  
Triggering Events ◽  
Test Patient

During mechanical ventilation, a disparity between flow, pressure and volume demands of the patient and the assistance delivered by the mechanical ventilator often occurs. This paper introduces an alternative approach of simulating and evaluating patient–ventilator interactions with high fidelity using the electromechanical lung simulator xPULM™. The xPULM™ approximates respiratory activities of a patient during alternating phases of spontaneous breathing and apnea intervals while connected to a mechanical ventilator. Focusing on different triggering events, volume assist-control (V/A-C) and pressure support ventilation (PSV) modes were chosen to test patient–ventilator interactions. In V/A-C mode, a double-triggering was detected every third breathing cycle, leading to an asynchrony index of 16.67%, which is classified as severe. This asynchrony causes a significant increase of peak inspiratory pressure (7.96 ± 6.38 vs. 11.09 ± 0.49 cmH2O, p < 0.01)) and peak expiratory flow (−25.57 ± 8.93 vs. 32.90 ± 0.54 L/min, p < 0.01) when compared to synchronous phases of the breathing simulation. Additionally, events of premature cycling were observed during PSV mode. In this mode, the peak delivered volume during simulated spontaneous breathing phases increased significantly (917.09 ± 45.74 vs. 468.40 ± 31.79 mL, p < 0.01) compared to apnea phases. Various dynamic clinical situations can be approximated using this approach and thereby could help to identify undesired patient–ventilation interactions in the future. Rapidly manufactured ventilator systems could also be tested using this approach.

scholarly journals Ventilator-Induced Diaphragm Dysfunction (Review)

2018 ◽  
Vol 14 (3) ◽  
pp. 82-103
Author(s):  
M. A. Babaev ◽  
D. B. Bykov ◽  
Т. M. Birg ◽  
M. А. Vyzhigina ◽  
A. A. Eremenko
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Contractile Function ◽  
Clinical Manifestations ◽  
Lung Ventilation ◽  
Respiratory Support ◽  
Diaphragm Dysfunction ◽  
Mechanical Lung ◽  
Mechanical Lung Ventilation ◽  
Ventilation Modes

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy. 

Respiratory phase locking during mechanical ventilation in anesthetized human subjects

1986 ◽  
Vol 250 (5) ◽  
pp. R902-R909 ◽  
Author(s):  
C. Graves ◽  
L. Glass ◽  
D. Laporta ◽  
R. Meloche ◽  
A. Grassino
Keyword(s):  
Spontaneous Breathing ◽  
Breathing Pattern ◽  
Human Subjects ◽  
Phase Locking ◽  
Phase Relationship ◽  
Mechanical Ventilator ◽  
Lung Inflation ◽  
Fixed Phase ◽  
Simple Phase ◽  
Ventilator Settings

The coupling patterns between the rhythm of a mechanical ventilator and the rhythm of spontaneous breathing were studied in enflurane-anesthetized adult human subjects. The spontaneous breathing pattern was altered in response to different frequencies and amplitudes of forced lung inflations. A 1:1 phase locking (the frequency of the mechanical ventilator is matched by the frequency of spontaneous breathing with a fixed phase between the 2 rhythms) was observed in a range of up to +/- 40% of some of the subject's spontaneous breathing frequencies. During 1:1 phase locking, there were marked changes in the expiratory duration as measured from the electromyogram of the diaphragm. The phase relationship between onset of inflation and onset of inspiration depended on the frequency and amplitude of mechanical inflation. At ventilator settings that did not give 1:1 phase locking, other simple phase-locked patterns, such as 1:2 and 2:1, or irregular non-phase-locked patterns were observed. Reflexes arising from lung inflation, which may underlie the entrainment, are discussed in the context of these results.

scholarly journals Adaptive split ventilator system enables parallel ventilation, individual monitoring and ventilation pressures control for each lung simulators

2020 ◽  
Author(s):  
Shahroor Sarit Hadar ◽  
Sarouf Yarden ◽  
Oz-Ari Leav ◽  
M Gilad ◽  
K. Joseph ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Minute Ventilation ◽  
Pressure Sensors ◽  
Peak Inspiratory Pressure ◽  
Safety Monitoring ◽  
Simulated Patient ◽  
Air Leak ◽  
Lung Simulator ◽  
Clinical Scenarios ◽  
Number Of Patients

AbstractObjectiveIn mass crisis setting such as the COVID-19 pandemic, the number of patients requiring invasive ventilation may exceed the number of available ventilators. This challenge led to the concept of splitting ventilator between several patients, which aroused interest as well as a strong opposition from multiple professional societies (The joint statement)1.Establishment of a safe ventilator splitting setup which enables monitoring and control of each ventilated patient would be a desirable ability. Achieving independency between the Co-vent patients would enable effective coping with different individual clinical scenarios and broaden the pairing possibilities of patients connected to a single ventilator. We conducted an experiment to determine if our designed setup achieves these goals.MethodsWe utilized a double two limbed modified ventilator circuits which were connected to dual lung simulators. Adding readily available pressure sensors (transducers), PEEP valves, flow control valves, one-way (check) valves and HME filters made the circuit safe enough and suitable for our goals. We first examined a single lung simulator establishing the baseline set parameters, while monitoring ventilator measures as Tidal Volume. The initial ventilator setting we chose was a controlled mandatory ventilation mode with a PIP (peak inspiratory pressure) of 25cmH2O, PEEP (Positive End Expiratory Pressure) of 5 cmH2O. In pressure control set at 20 cmH2O, the recorded mean TV(tidal volume) was 1000 mL (approximately 500 mL/lung simulator) with an average MV(minute ventilation) of 13 L/min (or 6.5 L/min/lung simulator). After examining the system with the dual modified circuits attached, and obtaining all the ventilation parameters, we simulated several clinical scenarios. We simulated clinical events such as: partial or full obstruction, disconnection, air leak and compliance differentials, which occur frequently on a ventilation course. Thus, it is a paramount system demand to keep undisturbed ventilation to the Co-vent patient A, while being challenged by patient B.ResultsThe adaptive split ventilator setup yields increased safety, monitoring, and controls ventilation parameters successfully for each connected simulated patient (using lung simulators).It also enables coping with several common clinical scenarios on a ventilation course, by allowing the care provider to control PIP and PEEP of each Co-Vent patient.ConclusionIn a mass crisis setting, when there is a shortage of ventilators supply, and as a last resort, this setup can be a viable option to act upon. This experiment demonstrates the ability of the split ventilator to ventilate dual lung simulators with increased safety, monitoring and ventilation pressures control of each simulated patient. This split ventilator kept supporting a simulated patient with undisturbed parameters while the CO-vent patient was simulated to be disconnected, having an air leak, or exhibiting lung compliance deterioration. To the best of our knowledge, this is the first time a split ventilator setup demonstrates these capabilities. Our pilot experiment suggests a significant potential of expanding the ventilator support resources, and is especially relevant during COVID-19 outbreak. Since this setup has not been used in a clinical setting yet, further research should be conducted to explore the safety limits and the capabilities of this model.

Mechanical Ventilator spontaneous breathing detection tested by robot SIMVENT

2015 ◽  
Author(s):  
Franco Simini ◽  
Adrian Monkas ◽  
Gonzalo Carballo ◽  
Jonatan Aguirre ◽  
Fabian Ferreira ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Mechanical Ventilator

scholarly journals New adjustable flow resistance design for mechanical lung simulator xPulm

2019 ◽  
Vol 52 (27) ◽  
pp. 434-439
Author(s):  
Oleksii Kozynets ◽  
Andreas Drauschke
Keyword(s):  
Flow Resistance ◽  
Mechanical Lung ◽  
Lung Simulator

scholarly journals "Airway Pressure Release Ventilation" a step up care in ARDS

2014 ◽  
Vol 2 (1) ◽  
pp. 35-37
Author(s):  
M Motiul Islam ◽  
Raihan Rabbani ◽  
M Mofizul Islam Polash ◽  
Ahmad Mursel Anam
Keyword(s):  
Spontaneous Breathing ◽  
Protective Effects ◽  
Mechanical Ventilator ◽  
Ongoing Trial ◽  
Intermittent Mandatory Ventilation ◽  
Safe Alternative ◽  
Open Lung ◽  
Pressure Release Ventilation ◽  
Pressure Controlled ◽  
Open Lung Approach

APRV is a mode of mechanical ventilator which uses the principal of open lung approach. It is thought to be an effective & safe alternative for difficult to oxygenate patients like ARDS. It is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. APRV has many purported advantages over conventional ventilation including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics and potential lung-protective effects. It has many claimed disadvantages related to risks of volumtrauma and increased energy expenditure related to spontaneous breathing. Though it was first described more than 20 years ago still it has not gained popularity till date as it is yet to prove its mortality benefits over other conventional modes. Currently there is a lot of ongoing trial globally on it. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19955 Bangladesh Crit Care J March 2014; 2 (1): 35-37

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