Closed Loop Ventilation

Size: px

Start display at page:

Download "Closed Loop Ventilation"

Bonnie Griffith
6 years ago
Views:

1 Closed Loop Ventilation Ken Hargett MHA RRT RCP FAARC FCCM Society of Critical Care Medicine

2 Perceived Need Growing Number of Mechanically Ventilated Patients Limited Workforce Evidence Based Practice Adherence (automated protocol) Facilitate Liberation from Ventilator

Current and Projected Workforce Requirements for Care of the Critically Ill and Patients With Pulmonary Disease: Can We Meet the Requirements of an Aging

3 Current and Projected Workforce Requirements for Care of the Critically Ill and Patients With Pulmonary Disease: Can We Meet the Requirements of an Aging Population? JAMA. 2000;284(21): doi: /jama Angus, D. Kelley, M. Schmitz, R. Committee on Manpower for Pulmonary and Critical Care

4 Increasing Number of Ventilated Patients Needham CCM 2005 Needham Projected Incidence of mechanical ventilation in Ontario to Critical Care Medicine 33(3):

5 6000 Houston Methodist Ventilated Patients Proj

6 AUTOMODE

7 NAVA Colombo D, Cammarota G, Bergamaschi V, et al: Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 2008;34: Spahija J, De Marchie M, Albert M, et al: Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 2010;38: Brander L, Leong-Poi H, Beck J, et al: Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 2009;135: Beck J, Reilly M, Grasselli G, et al. Patient ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 2009;65:663-8.

8 PAV Sinderby C, Beck J: Proportional assist ventilation and neurally adjusted ventilatory assist better approaches to patient-ventilator synchrony? Clin Chest Med 2008;29: Xirouchaki N, Kondili E, Vaporidi K, et al: Proportional assist ventilation with load-adjustable gain factors in critically ill patients: comparison with pressure support. Intensive Care Med 2008;34: Younes M: Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 1992; 145: Bosma K, Ferreyra G, Ambrogio C, et al: Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 2007;35: Alexopoulou C. Sleep during proportional-assist ventilation with loadadjustable gain factors in critically ill patients. Intensive Care Med 2007;33:

9 SmartCare Lellouche F et al. A Multicenter Randomized Trial of Computer-driven Protocolized Weaning from Mechanical Ventilation. Am J Respir Crit Care Med Vol 174. pp , 2006 Schädler. Dirk,. Engel, Christoph, Elke, Gunnar. Automatic Control of Pressure Support for Ventilator Weaning in Surgical Intensive Care Patients. American Journal of Respiratory and Critical Care Medicine, Vol. 185, No. 6 pp Burns, K.. Meade, Lessard, M,. Hand, l. et al. Wean Earlier and Automatically with New Technology (the WEAN Study). A Multicenter, Pilot Randomized Controlled Trial, American Journal of Respiratory and Critical Care Medicine, Vol. 187, No. 11 (2013), pp

10 ASV Lellouche F, Bouchard PA, Simard S, L'Her E, Wysocki M Evaluation of fully automated ventilation: a randomized controlled study in postcardiac surgery patients Intensive Care Med Mar;39(3): Arnal JM, Garnero A, Novotni D, Demory D, Ducros L, Berric A, Donati SY, Corno G, Jaber S, Durand-Gasselin J. Feasibility study on full closed-loop control ventilation (INTELLiVENT-ASV) in ICU patients with acute respiratory failure: a prospective observational comparative study Crit Care Sep 11;17(5):R196 Arnal JM, Wysocki M, Novotni D, Demory D, Lopez R, Donati S, Granier I, Corno G, Durand-Gasselin J Safety and efficacy of a fully closed-loop control ventilation (INTELLiVENT-ASV) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover Study. Intensive Care Med May;38(5):781-7

11 ASV Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients Intensive Care Med May;40(5):752-3 Jouvet P, Eddington A, Payen V, Bordessoule A, Emeriaud G, Gasco RL, Wysocki M A pilot prospective study on closed loop controlled ventilation and oxygenation in ventilated children during the weaning phase. Crit Care May 16;16(3):R85

12 ASV STUDIES 25 clinical studies 6 abstracts 3 bench studies 5 reports the expiratory time constant

13 Some Study EndPoints OF CLOSED LOOP Decreased Vent Length of Stay Increased Time at Optimal Ventilation Reduced Caregiver Interactions Decreased Alarm Activations

14 Prolonged High SpO2 and excessive oxygen concentrations Suzuki, S. Eastwood, G. Peck L. et al: Current oxygen management in mechanically ventilated patients: a prospective observational study. J Ctic Care 28: de Graaff A., Dongelmans, D. et al. Clinician s response to hyperoxia in ventilated pateintsin a Dutch ICU depends on the FiO2. Intensive Care med 37:

15 Rachmale S, Li G, Wilson G, et al: Practice of excessive F(IO(2)) and effect on pulmonary outcomes in mechanically ventilated patients with acute lung injury. Respir Care 2012; 57: de Graaff AE, Dongelmans DA, Binnekade JM, et al: Clinicians response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2. Intensive Care Med 2011; 37:46 51 Suzuki S, Eastwood GM, Peck L, et al: Current oxygen management in mechanically ventilated patients: A prospective observational cohort study. J Crit Care 2013; 28:

16 Adoption of Closed Loop 33% of Houston Methodist patient on ASV patients/day 3 years of training (RT, Nursing,MD) Annual Course (Simulation, Case Studies, Animal Model) Understanding of Algorithms Understanding of Interface

This bibliography is a literature reference for users and represents selected relevant publications, without any claim to completeness.

Bibliography INTELLiVENT-ASV This bibliography is a literature reference for users and represents selected relevant publications, without any claim to completeness. Table of Contents 1 Closed-loop ventilation