Closed-loop Control in Mechanical Ventilation

  • C. Chopin
  • M. C. Chambrin
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1993 book series (YEARBOOK, volume 1993)


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 [1]. 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 [2]. 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.


Mechanical Ventilation Respiratory Rate Pressure Support Intermittent Mandatory Ventilation Pressure Support Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Downs JB, Klein EF, Desautels M, et al. (1973) Intermittent Mandatory Ventilation: A new approach to weaning patients from mechanical ventilators. Chest 64: 331–335PubMedCrossRefGoogle Scholar
  2. 2.
    Abraham E, Yoshihara G (1989) Cardio-respiratory effects of pressure controlled inverese ration ventilation in severe respiratory failure. Chest 96: 1356–1359PubMedCrossRefGoogle Scholar
  3. 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
  4. 4.
    Roussos C, Macklem PT (1982) The respiratory muscles. N Engl J Med 307: 786–793PubMedCrossRefGoogle Scholar
  5. 5.
    Westenskow RD (1987) Closed loop control of blood pressure, Ventilation and anesthesia delivery. Int J Clin Monit Comp 4: 69–74CrossRefGoogle Scholar
  6. 6.
    Sheppard LC, Konchonkos NT (1977) Automation of measurements and interventions in the systematic care of postoperative cardiac surgical patients. Med Instrum 11: 296–301PubMedGoogle Scholar
  7. 7.
    Frumin MJ, Bergman NA, Holaday DA (1959) Carbon dioxide and oxygen blood levels with a carbon dioxide controlled artificial respirator. Anesthesiology 3: 313–320CrossRefGoogle Scholar
  8. 8.
    Massaro TA, Behrens-Tepper J, Updike SJ (1976) Non-polarographic blood gas analysis. In-vitro evaluation of gas Chromatograph system. Biomater Med Devices Artif Organs 4: 385–389PubMedGoogle Scholar
  9. 9.
    Hall JR, Poulton TJ, Downs JB, Hawkins IF, Crawford CA (1980) In vivo arterial blood gas analysis: An evaluation. Crit Care Med 8: 414–417PubMedCrossRefGoogle Scholar
  10. 10.
    Mitara Y, Mikami T, Yamamoto K, Kimura M (1975) A dual control system for assisting respiration. Med J Bio Eng 11: 846–854CrossRefGoogle Scholar
  11. 11.
    Coles JR, Brown WA, Lampond DG (1973) Computer control of respiration and anesthesia. Med J Biol Eng 11: 262–267CrossRefGoogle Scholar
  12. 12.
    Ohlson KB, Westenskow DR, Jordan WS (1982) A mieroprocessor based feedback Controller for mechanical Ventilation. Ann Biomed Eng 10: 35–48PubMedCrossRefGoogle Scholar
  13. 13.
    Chopin C, Chambrin MC, Mangälaboyi J, Lestavel P, Fourrier F (1989) Carbon dioxide mandatory Ventilation (MVC02) a new method for weaning from mechanical Ventilation. Int J Clin Monit Comput 6: 11–19PubMedCrossRefGoogle Scholar
  14. 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. 15.
    Hill DW (1960) Respiratory dead Space and arterial to endtidal C02 tension difference in anaesthetized man. J App Physiol 15: 383–388Google Scholar
  16. 16.
    Westenskow DR (1981) Control of PaC02 during mechanical Ventilation: Monitoring and feedback techniques. Ann Biomed Eng 9: 649–657CrossRefGoogle Scholar
  17. 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
  18. 18.
    Carlon GC, Ray C, Miodownik S, Kopec I, Groeger JS (1988) Capnography in mechanically ventilated patients. Crit Care Med 16: 550–556PubMedCrossRefGoogle Scholar
  19. 19.
    East TD, Veen JC, Jonker T, Pace LN, Mc James S (1988) Computer-controlled positive endexpiratory pressure titration for effective oxygenation without frequent blood gases. Crit Care Med 16: 252–257PubMedCrossRefGoogle Scholar
  20. 20.
    Hewlett AM, Platt AS, Terry VG (1977) Mandatory minute Ventilation: A new concept in weaning from mechanical Ventilation. Anesthesia 32: 163–168CrossRefGoogle Scholar
  21. 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
  22. 22.
    Laubscher T, Heinrichs W, Weiler N, Hartmann G, Brunner JX (1992) Minimal alveolar Ventilation Controller. Proceedings of the 14th Annual International Conference of the IEEE Engi-neering in Medicine and Biology Society, Paris, pp 2711–2712CrossRefGoogle Scholar
  23. 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. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • C. Chopin
  • M. C. Chambrin

There are no affiliations available

Personalised recommendations