Closed-loop Control in Mechanical Ventilation
In the 1960s and the 1970s, control and assist volume controlled modes were the state-of-the-art for mechanical Ventilation. The aim was to maintain normal gas exchange and blood gas values. By the end of the 1970s, most clinieians realized the importance to allow the patients to breath spontaneously between the controlled respiratory cycles. Intermittent mandatory Ventilation (IMV) as the first available partial mode was received enthusiastieally . The aim shifted from normal gas exchange to maintain normal conditioning of the respiratory muscles, and to increase the patient’s chances of rapid weaning. The 1980s introduced microprocessors, demand flow system, and extensive monitoring into the design of Ventilators. These new technologies updated pressure control modes. The aim became to reduce the patient’s work of breathing and to minimize pulmonary barotrauma. Partial ventilatory support and pressure control mode became widely recommended even during the acute phase of respiratory failure . In most critically ill patients, partial ventilatory support is preferable to füll support for several reasons: First, the patient adapts himself to the respirator, determines his own breathing pattern and requires less or no sedation; second, the decrease in intrapleural pressure, associated with spontaneous inspiratory activity, increases cardiac Output and consequently oxygen delivery; and third, atrophy of the respiratory muscles and diaphragm is likely avoided.
KeywordsMechanical Ventilation Respiratory Rate Pressure Support Intermittent Mandatory Ventilation Pressure Support Level
Unable to display preview. Download preview PDF.
- 3.Shapiro AB (1992) New Ventilator technology: Impact on patient care. In: Critical Care, State of the Art. Society of Critical Care Medicine, vol. 13, pp 17–43Google Scholar
- 14.Raemer DB, Francis D, Philip JH, Gabel RA (1983) Variation in PC02 between arterial blood and peak expired gas during anesthesia. Anest Anaig 62: 1065–1069Google Scholar
- 15.Hill DW (1960) Respiratory dead Space and arterial to endtidal C02 tension difference in anaesthetized man. J App Physiol 15: 383–388Google Scholar
- 17.Chopin C, Mangalaboyi J, Chambrin MC, et al. (1990) Evaluation de la PaCO2 à partir de la pression partielle de gaz carbonique de fin d’expiration. In: Soeiete de Reanimation de Langue Française (ed), Réanimation-Urgence. Paris, pp 375–383Google Scholar
- 21.Boyer F, Bruneau B, Gaussorgues P, Jay-Lassonnery S, Robert D (1989) Aide inspiratoire avec asservissement du niveau de pression: Volume ventilé minute versus fréquence ventilatoire. Réan Soins Intens Méd Urg 5: 227–232Google Scholar
- 23.Chambrin MC, Chopin C, Mangalaboyi J, Lestavel P, Rime A, Fourrier F (1992) Autoregulated inspiratory support Ventilation. Intensive Care Med 18: S 74Google Scholar
- 24.Dojat M, Brochart L, Harf A (1991) A knowledge-based system for the management of the weaning procedure of mechanically ventilated patients. Proceedings of the 12th Annual International Symposium on Computer Assisted Decision Support and Data Base Management in Anesthesia, Intensive Care and Cardiopulmonary Medicine, RotterdamGoogle Scholar