Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device

Schmidt, Johannes; Wenzel, Christin; Mahn, Marlene; Spassov, Sashko; Schmitz, Heidi Cristina; Borgmann, Silke; Lin, Ziwei; Haberstroh, Jörg; Meckel, Stephan; Eiden, Sebastian; Wirth, Steffen; Buerkle, Hartmut; Schumann, Stefan

doi:10.1097/eja.0000000000000819

Cited by 52 publications

(84 citation statements)

References 31 publications

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“…The implications of obesity on respiratory system mechanics are well known: chest wall mechanics are impaired, and respiratory system compliance is reduced. Obese patients have an increased risk for early expiratory alveolar collapse and potential consecutive atelectrauma [3,5,17,19,20] and thus for decreased functional residual capacity and expiratory reserve volume [5,13,21,22]. Values are stated as mean ± SD.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretical and clinical observations predict that the linearized decrease in expiratory airway pressure has a beneficial impact on the intrapulmonary inhomogeneity [6,7,9,17,24]. However, the comparison of tidal impedance variation revealed no differences in intrapulmonary gas distribution during the different ventilation phases.…”

Section: Discussionmentioning

confidence: 99%

“…We did not perform arterial blood gas analyses to examine the effects of FCV on gas exchange in our patients. In preclinical [17] and clinical studies [8], the controlled expiration improved oxygenation and CO 2 elimination. However, in contrast to other centers, placing an arterial line is not part of our standard treatment in this patient group.…”

Section: Limitations Of the Studymentioning

confidence: 99%

“…In regard to previous investigations on gas exchange during FCV in a porcine model of ARDS [17] and the crossover design (paired test conditions) we assumed a standardized effect size of the primary endpoint of 0.7 (being the quotient of differences in means and SD). To reach a test power of 0.8 and a desired level of significance of 0.05, 19 patients were required.…”

Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

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Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

et al. 2020

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Background: In obese patients, high closing capacity and low functional residual capacity increase the risk for expiratory alveolar collapse. Constant expiratory flow, as provided by the new flow-controlled ventilation (FCV) mode, was shown to improve lung recruitment. We hypothesized that lung aeration and respiratory mechanics improve in obese patients during FCV. Methods:We compared FCV and volume-controlled (VCV) ventilation in 23 obese patients in a randomized crossover setting. Starting with baseline measurements, ventilation settings were kept identical except for the ventilation mode related differences (VCV: inspiration to expiration ratio 1:2 with passive expiration, FCV: inspiration to expiration ratio 1:1 with active, linearized expiration). Primary endpoint of the study was the change of endexpiratory lung volume compared to baseline ventilation. Secondary endpoints were the change of mean lung volume, respiratory mechanics and hemodynamic variables.Results: The loss of end-expiratory lung volume and mean lung volume compared to baseline was lower during FCV compared to VCV (end-expiratory lung volume: FCV, − 126 ± 207 ml; VCV, − 316 ± 254 ml; p < 0.001, mean lung volume: FCV, − 108.2 ± 198.6 ml; VCV, − 315.8 ± 252.1 ml; p < 0.001) and at comparable plateau pressure (baseline, 19.6 ± 3.7; VCV, 20.2 ± 3.4; FCV, 20.2 ± 3.8 cmH 2 O; p = 0.441), mean tracheal pressure was higher (baseline, 13.1 ± 1.1; VCV, 12.9 ± 1.2; FCV, 14.8 ± 2.2 cmH 2 O; p < 0.001). All other respiratory and hemodynamic variables were comparable between the ventilation modes.Conclusions: This study demonstrates that, compared to VCV, FCV improves regional ventilation distribution of the lung at comparable PEEP, tidal volume, P Plat and ventilation frequency. The increase in end-expiratory lung volume during FCV was probably caused by the increased mean tracheal pressure which can be attributed to the linearized expiratory pressure decline.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitations Of the Studymentioning

confidence: 99%

Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

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Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

et al. 2020

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“…In FCV, this part of the curve has been linearized, meaning that the flow is constant during the whole expiration. This new ventilation strategy has been tested in animal models and showed improved lung recruitment and oxygenation (13).…”

Section: Flow-controlled Ventilationmentioning

confidence: 99%

Evone® Flow-Controlled Ventilation During Upper Airway Surgery: A Clinical Feasibility Study and Safety Assessment

et al. 2020

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Introduction: During upper airway surgery in a narrowed airway due to tumor or stenosis, safe ventilation, good laryngotracheal exposure, and preservation of an adequate surgical working space are of paramount importance. This can be achieved by small-lumen ventilation such as High Frequency Jet Ventilation (HFJV). However, this technique has major drawbacks, such as air-trapping and desaturation in patients with poor pulmonary reserve. Recently, an innovative ventilating system with flow-controlled ventilation (FCV) and a small-lumen endotracheal tube, the Evone ® (Ventinova, Eindhoven, The Netherlands), was introduced, claiming to counter the drawbacks of HFJV.Objectives: To evaluate feasibility and safety of the Evone ® FCV system in difficult upper airway surgery and to critically appraise this novel ventilation method.Patients and methods: Evone ® is a FCV-device using a small-bore cuffed tube (Tritube ® ). This ventilator actively sucks air out of the lungs, rather than relying on the passive backflow of air like in HFJV. Data related to the medical history, surgery, and anesthesia of all consecutive patients undergoing upper airway surgery with Evone ® FCV ventilation were included in a tertiary center retrospective observational study.Results: Fifteen Patients, with a median age of 54 years, were included. Surgical procedures and indications included laser-assisted endoscopic treatment of idiopathic subglottic stenosis (n = 3), tracheal stenosis (n = 1), and posterior glottic stenosis (n = 2), biopsy and/or Transoral Laser Microsurgery for laryngeal (pre)malignancy (n = 7) and resection of benign lesions with posterior (supra)glottic location (n = 2). Mean ventilation duration was 52.0 min (range 30-115 min, SD 19.6 min), mean surgery duration was 31.7 min (range 15-65 min, SD 13.2 min), mean minimal SaO 2 was 96.3% (range 89-100%, SD 4.0%) and mean peak pCO 2 was 41.4 mmHg (range 31-50 mmHg, SD = 5.5 mmHg). No anesthesia-or surgery-related complications, adverse events or intra-operative difficulties were reported during or after any of the 15 procedures. In all cases, compared to HFJV, Evone ® FCV ventilation allowed a superior visualization and working space during the surgical procedure.Meulemans et al. Evone ® During Upper Airway SurgeryConclusion: The Evone ® FCV ventilation system provides excellent conditions in patients undergoing upper airway surgery, as it combines excellent accessibility and visibility of the operation site with safe and stable ventilation.

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Airway management during unusual tracheal stenosis: A clinical feasibility trial

Altun,

Canbaz,

Altun

et al. 2023

Laryngoscope Investig Oto

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ObjectivesProlonged intubation is a known risk factor of LTS. LTS related to COVID‐19 may result in a different phenotype: pronation affects the location of stenosis and COVID‐19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow‐controlled ventilation (FCV) in the management of patients with COVID‐19‐related LTS undergoing laryngeal surgery.Methods20 patients suffering from COVID‐19‐related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO2 laser, were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated.ResultsMedian duration of mechanical ventilation during their ICU stay was 17 days, (range, 7–27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons’ satisfaction on the view was rated 9 out of 10 (range 7–10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of “respiratory complication.”ConclusionThis study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics.Level of EvidenceIV, non‐comparitive prospective clinical trial with 20 patients.

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Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device

Abstract: Supplemental Digital Content is available in the text

Cited by 52 publications

References 31 publications

Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

Evone® Flow-Controlled Ventilation During Upper Airway Surgery: A Clinical Feasibility Study and Safety Assessment

Airway management during unusual tracheal stenosis: A clinical feasibility trial

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