Ashbaugh and colleagues [1] in 1969 have used low levels positive end-expiratory pressure (PEEP) with volume controlled ventilation (VCV) (5–10 cm H2O) in the treatment of hypoxemia in adult respiratory distress syndrome (ARDS). They also indicated that higher levels of PEEP could cause barotrauma, decrease cardiac output and therefore decrease O2 transport although PaO2 is increased. Falke and coworkers [2] defined in 1972 the “optimal PEEP” as a level of PEEP which provided a PaO2 > 100 mm Hg with FiO2 ≤0.5. In 1975, Suter and colleagues [3] accepted the “optimal PEEP” as a value providing best oxygen transport and lung compliance, which could be obtained with a PEEP level up to 12 cm H2O. Application of PEEP has been reported to lower cardiac output [3, 4]. However, Qvist et al. [5] demonstrated in 1975 that the adverse hemodynamic effects of PEEP could be limited by additional fluid administration.

Advantages and Rationale for Pressure Controlled Ventilation

The theoretical approach along with the rationale of harmonic excitation modality (HEM) applied as optimal dual controlled ventilation (DCV) to anaesthetized or severe brain injured patients, whose respiretory mechanics can be properly assumed steady and linear, are presented and discussed. The design criteria of an improved version of the Advanced Lung Ventilation System (ALVS), including HEM in its functional features, are described in details. In particular, the elimination of any undesiderable artificial distortion affecting the respiratory and ventilation pattern waveforms is achieved by maintaining continuous forever the airflow inside the ventilation circuit, ensuring also the highest level of safety for patient in any condition. In such a way, the full-time compatibility of controlled breathings with spontaneous breathing activity of patient during continuous positive airways pressure (CPAP) or bilevel positive airways pressure (BiPAP) ventilation modalities and during assisted/controlled ventilation(A/CV), includeing also synchronized or triggered ventilation modalities, is an intrinsic innovative feature of the system available for clinical application. As expected and according to the clinical requirements, HEM provides for physiological respiratory and ventilation pattern waveforms together with optimal “breath to breath” feedback control of lung volume driven by an improved diagnostic measurement procedure, whose outputs are also vital for adapting all the preset ventilation parameters to the current value of the respiratory parameters of patient. The results produced by software simulations concerning both adult and neonatal patients in different clinical conditions are completely consistent with those obtained by the theoretical treatment, showing that HEM reaches the best performances from both clinical and engineering points of view.

/pdf/harmonic-excitation-of-linear-respiratory-mechanics-for-50y08yypxn.pdf

Harmonic excitation of linear respiratory mechanics for physiological dual controlled ventilation

Bei dieser kontrollierten Beatmungsform wird das Hubvolumen dosiert und konstantgehalten. Wird gleichzeitig die Frequenz festgelegt, so bleibt das Minutenvolumen konstant. Der inspiratorische Flow variiert zwischen konstantem und dezelerierendem Flowmuster. Bei der volumenkontrollierten Beatmung mus der Atemwegsspitzendruck uberwacht werden.

Volumenkontrollierte vs. druckkontrollierte Beatmung

In patients with predanirnnt rig -tt ventricular infaretim sinus rhythm is dally important to preserve atrial systole because of adequate rigit ventricular filling. Aitha(i beneficial I rXlyrsuic influence of AV sequential pacing ras rexrtusi in atme previous studies, this method is not being routinely used in the acute infartion settirg. We used AV sequential pacing in 7 patients with acute inferior my dial infarctim and right vattricular involvement. Predarrinant ri.it ventricular failure vias confirmed lr CVP, being equal or g eater than PPP. In all patients ventricular paeirg (70 80/t m) was started on ad<rdssicn because of AV block III*. Cardicenie stork with typical clinical sigis, of ,mia (< 20 ml/h) and lactic acidosis developed in all patients between first and fifth day of hospital stay. Shock vas refractory to volure leading with plasm ex mrrlirg agent (until PPCP 18 mm Ig ras tom), inotropic dry (dopeiin 6 12 n /kg/min and dobitaiin 4 18 mcgfkWmin in all patients, norepirmIrire 0.2 erg/kg/ min in 2 patients), and controlled nmrtmnicai ventilation in 3 patients. After AV sequential pacing (70 80/ruin, AV interval 150 180 ms) was mployed instead of ventricular, va observed sigv.fica t and iimssiiate incrvms^ in cardiacmit mean value 1.9 1/mit e ([arge 1.6 -.2.ü 1/minim to 2.7 1/rein/[ f(range 2.2 3.1 1/min/m ). CVP and P1CP were not sigpificantly altered. In one patient atrial stimulation was not efficient despite the proper position of el ctrc e, acid he died in cirdiogenic shock. Signs of shock disappeared in 6 patients, 5 patients survived and were di.]thargcd. CYO patient dial after the slats rttyths Uns recovered bemuse of sudda i refractory left ventricular failure. We conclude that AV se tial pacing sigraficantiy improves cardiac output in patients with preisuni ant ri t ventricular infarction, AV block III* and cardicgerdc stock. We believe that it sYruld be routinely used in such patients eves before irotropic dnBs.

/pdf/pressure-controlled-ventilation-in-ards-27bqhgosuv.pdf

Pressure controlled ventilation in ARDS

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Pressure controlled ventilation in ARDS