Variable mechanical ventilation

Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini, Luiz Alberto; Friedman, Gilberto

doi:10.5935/0103-507x.20170012

Cited by 5 publications

(7 citation statements)

References 48 publications

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“…Current clinical ventilators, however, only utilize conventional ventilation (CV) in which both the delivered tidal volume and respiratory rate are fixed. On the other hand, VV provides physiological variation in tidal volumes and breathing frequencies on a breath-by-breath basis, which, in a mathematical model predicted to improve recruitment of atelectatic lung regions 23 , confirmed later by many animal studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37] . Hence, with a distinct amplitude and frequency at each breath, the lung is exposed to multiple frequencies and tidal volumes surrounding those of natural breathing without the requirement of additional equipment.…”

mentioning

confidence: 79%

“…First, the study was administered when patients were in a stable condition and VV was always preceded by CV. Therefore, while statistically speaking improvement and deterioration would be equally likely, all 5 patients showed a decrease in both R and E. Second, previous studies provided evidence of improvement in lung mechanics, gas exchange, as well as reduction in ventilator-induced lung injury following VV compared to CV in both healthy and injured lungs of many animal models including pigs, mice, rats, and sheep [24][25][26][27][28][29][30][31][32][33][34][35][36][37] . Clinically, VV was also shown to improve gas exchange and respiratory mechanics 53 , improve patient-ventilator synchrony 54 , and reduce inflammatory response 55 .…”

Section: Human Clinical Trial Frommentioning

confidence: 92%

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Tracking respiratory mechanics around natural breathing rates via variable ventilation

Jawde

Walkey

Majumdar

et al. 2020

Sci Rep

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Measuring respiratory resistance and elastance as a function of time, tidal volume, respiratory rate, and positive end-expiratory pressure can guide mechanical ventilation. However, current measurement techniques are limited since they are assessed intermittently at non-physiological frequencies or involve specialized equipment. to this end, we introduce ZVV, a practical approach to continuously track resistance and elastance during Variable Ventilation (VV), in which frequency and tidal volume vary from breath-to-breath. ZVV segments airway pressure and flow recordings into individual breaths, calculates resistance and elastance for each breath, bins them according to frequency or tidal volume and plots the results against bin means. ZVV's feasibility was assessed clinically in five human patients with acute lung injury, experimentally in five mice ventilated before and after lavage injury, and computationally using a viscoelastic respiratory model. ZVV provided continuous measurements in both settings, while the computational study revealed <2% estimation errors. Our findings support ZVV as a feasible technique to assess respiratory mechanics under physiological conditions. Additionally, in humans, ZVV detected a decrease in resistance and elastance with time by 12.8% and 6.2%, respectively, suggesting that VV can improve lung recruitment in some patients and can therefore potentially serve both as a dual diagnostic and therapeutic tool.Respiratory resistance (R) and elastance (E) in mechanically ventilated patients relate to disease severity and progression, and patient response to treatment or changes in ventilator settings 1-3 . The manner in which R and E vary with frequency can reflect lung heterogeneity, a sensitive indicator of pathology 4 . Thus, a technique that can continuously and reliably assess R and E at physiological frequencies and tidal volumes (V T 's) could advance the treatment of mechanically ventilated patients. For example, increases in R can reveal bronchospasm 5 or a blocked endotracheal tube 6,7 , while increases in E can reflect pulmonary edema and alveolar derecruitment 8,9 . Tracking continuously R and E including their frequency dependencies could improve patient management via detection of airway obstruction in asthma, or optimization of mechanical ventilator settings for preventing ventilation-induced lung injury 10-15 .Nevertheless, estimates of R and E are rarely performed in clinical practice 16 , likely due to current strategies of intermittent end inspiratory occlusion measurements that require deep patient sedation or paralysis or the need for specialized equipment 10,17 . In order to adjust ventilation settings, clinicians are currently guided by gas exchange parameters, breath-to-breath peak pressures, and plateau pressures 16,[18][19][20] . However, these measures lack the ability to reveal whether abnormalities in mechanics are related to altered R or E and often require a heavily sedated or paralyzed patient 9,21 . The limitations in measuring R and E are not only pres...

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confidence: 79%

Section: Human Clinical Trial Frommentioning

confidence: 92%

Tracking respiratory mechanics around natural breathing rates via variable ventilation

Jawde

Walkey

Majumdar

et al. 2020

Sci Rep

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“…Variable ventilation (VV) was evaluated in experimental studies, which demonstrate beneficial effects of this strategy in respiratory mechanics, gas exchange and pulmonary function in models with and without lung injury (20). However, there are only three clinical studies that have evaluated this approach, and the objectives as well as the outcomes evaluated are different on those studies (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Oscilatory PEEP (BiPEEP) Improves Oxygenation and Reduces Inflammation in an Experimental Model of ARDS

Júnior¹,

Forgiarini²,

Mariano³

et al. 2023

Preprint

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To compare the use of variable mechanical ventilation with conventional mechanical ventilation in porcine model of ARDS. Methods: Animals were divided into two groups (n = 6), conventional ventilation and variable ventilation with bi-oscillatory PEEP. For induction of ARDS, intravenous oleic acid was used until a P/F ratio of 200 to 300 mmHg. The animals were ventilated with pressure control, FiO2 1.0, inspiration-expiration ratio = 1:2, tidal volume 6 ml/kg with the initial respiratory rate adjusted to maintain an end tidal CO2 tension of 35 to 45 mmHg. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cmH2O every 4 respiratory cycles, in convencional ventilation group PEEP was set from 5 cmH2O. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) and histological analyzes were evaluated; Results: The use of BiPEEP demonstrated improvement in lung compliance and PaO2 in relation to control. The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. In IL8 there was a significant increase in the lung base of control in relation to BiPEEP, and a reduction in the apex of BiPEEP in relation to control. The control group showed changes in lung morphology characterized by cellular infiltrates, a thickening of the alveolar septae and atelectasis, which were attenuated in BiPEEP group; (4) Conclusions: The use of variable ventilation with bi-oscillatory level of PEEP demonstrates a potential ventilatory strategy in an experimental model of ARDS.

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“…In clinical practice, integrating EIT with variable ventilation could potentially transform patient outcomes in critical care by enabling a more precise management of ventilatory support, particularly in patients with heterogeneous lung diseases. The synergy between EIT and variable ventilation could lead to improved strategies in managing ARDS, where lung protection and optimization of gas exchange are crucial [19,21].…”

Section: Potential Role Of Eit In Guiding Variable Ventilationmentioning

confidence: 99%

Electrical Impedance Tomography: A Narrative Review on Technology Principles and Its Current and Future Fields of Application

Cappellini,

Campagnola,

Consales

2024

Preprint

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Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strate-gies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: This narrative review explores the principles and applications of EIT, variable ventilation, and AI in critical care. EIT’s impedance sensing creates dynamic images of internal physiology, aiding in the management of conditions like Acute Respiratory Distress Syndrome (ARDS). Variable ventilation mimics natural breathing variability to improve lung function and minimize ventilator-induced lung injury. AI enhances EIT through advanced image reconstruction techniques, neural networks, and digital twin technology, offering more accurate diagnostics and tailored therapeutic interventions. Conclu-sions: The confluence of EIT, variable ventilation, and AI represents a significant advancement in critical care, enabling a predictive, personalized approach. EIT provides real-time insights into lung function, guiding precise ventilation adjustments and therapeutic interventions. AI inte-gration enhances EIT's diagnostic capabilities, facilitating the development of personalized treatment plans. This synergy fosters interdisciplinary collaborations and sets the stage for in-novative research, ultimately improving patient outcomes and advancing the future of critical care.

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Variable mechanical ventilation

Cited by 5 publications

References 48 publications

Tracking respiratory mechanics around natural breathing rates via variable ventilation

Tracking respiratory mechanics around natural breathing rates via variable ventilation

Oscilatory PEEP (BiPEEP) Improves Oxygenation and Reduces Inflammation in an Experimental Model of ARDS

Electrical Impedance Tomography: A Narrative Review on Technology Principles and Its Current and Future Fields of Application

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