Total versus tube‐related additional work of breathing in ventilator‐dependent patients

Haberthür, Christoph; Elsässer, S; Eberhard, L.; Stocker, Reto; Guttmann, J.

doi:10.1034/j.1399-6576.2000.440615.x

Cited by 58 publications

(28 citation statements)

References 10 publications

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“…Wird dieses Verfahren ein-bis zweimal täglich angewendet, so sollte Unterkompensation infolge Sekretablagerung wirkungsvoll verhindert werden können. [26]. Obwohl die zusätzliche, durch den Tubuswiderstand bedingte Atemarbeit auch mit einer geeignet hohen (konstanten) Druckunterstützung im Modus PSV wirkungsvoll vermindert werden kann, geht diese Art der Tubuskompensation unweigerlich mit einer Über-druckbeatmung (infolge der unvermeidbaren Überkompensation des Tubuswiderstandes), und dementsprechend immer auch mit einer partiellen Beatmung des Patienten einher [13,26].…”

Section: Partielle Tubusobstruktionunclassified

Automatische Tubuskompensation (ATC)

Guttmann¹,

Haberthür

Stocker

et al. 2001

Anaesthesist

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The endotracheal tube (ETT) is a considerably flow-dependent and, therefore, variable mechanical load. Conventional modes of respiratory support cannot adequately compensate for the tube resistance in inspiratorion and not at all in expiration. Automatic tube compensation (ATC) compensates for the flow-dependent pressure drop across the tracheal tube by a positive pressure support in inspiration and by a negative pressure support in expiration. The pressure support closely follows the nonlinear pressure-flow curve of the ETT. Automatic tube compensation has an indirect closed-loop working principle since the target tracheal pressure is not directly measured but rather calculated from continuously measured airway pressure and flow rate. It is not an own ventilatory mode but rather a component of flow-proportional pressure support which can be combined with all conventional ventilatory modes, and provides a rational basis for subdividing the pressure support to overcome the mechanical load of the tubing and to overcome that of the respiratory system. Partial tube obstructions, which could decrease the effectivity of ATC, could be detected automatically by analysing the expiratory flow signal using a software, which could be easily implemented into the ventilator. The effectivity of ATC during long-term application can be maintained by intermittent short-term measurement of the tracheal pressure. Up to now there is no commercially available ventilator which allows complete expiratory ATC. Studies in volunteers and in mechanically ventilated patients have convincingly shown that ATC reduces work of breathing and increases respiratory comfort. In addition, successful extubation could be better predicted with this mode in difficult-to-wean patients compared to other modes. There are no special rules in the clinical application of ATC. However, to prevent overassist the support level of the ventilatory mode which is combined with ATC should be reduced.

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Section: Partielle Tubusobstruktionunclassified

Automatische Tubuskompensation (ATC)

Guttmann¹,

Haberthür

Stocker

et al. 2001

Anaesthesist

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“…Banner, et al (1994) The literature supported the fact that there is an increase in WOBi with airways but results of the studies showed considerable differences. Straus et al (1998) found the WOB of the ETT to be approximately 11% while Haberthur et al (2000) measured the tube related WOB at approximately 52%. Straus et al used the acoustic reflection method to measure resistance of the ETT and supraglottic airway (1998) while Keidan et al (2000) and Haberthur et al (2000) used traditional flowmeters, esophageal balloons, and tracheal measurements to obtain their data.…”

Section: Introductionmentioning

confidence: 99%

“…Straus et al (1998) found the WOB of the ETT to be approximately 11% while Haberthur et al (2000) measured the tube related WOB at approximately 52%. Straus et al used the acoustic reflection method to measure resistance of the ETT and supraglottic airway (1998) while Keidan et al (2000) and Haberthur et al (2000) used traditional flowmeters, esophageal balloons, and tracheal measurements to obtain their data. All of the studies used small sample sizes and the populations varied from pediatric patients to adults.…”

Section: Introductionmentioning

confidence: 99%

Imposed Work of Breathing of Airway Adjuncts

Skinner¹,

Gilmer²,

Molloy³

et al. 2004

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“…17 In ATC mode, a ventilator measures flow and calculates the pressure required to overcome the flow-dependent resistive work load of the ETT. [5][6][7][8][9] The ATC calculations/algorithms are assuming a new, clean, and not deformed tube; because the calculation is based on the inner diameter and length of the ETT as well as on the measured flow, changes in the inner diameter of the ETT can hamper the accuracy of this calculation. Decrease in inner diameter induces increase in resistance, thus pressure drop is underestimated, and compensation is insufficient.…”

Section: Introductionmentioning

confidence: 99%

“…4 Automatic tube compensation (ATC) was developed to overcome the ETT-imposed respiratory work load. [5][6][7][8][9] ATC is designed to increase airway pressure by continuously calculating the pressure drop across the ETT (⌬P ETT ) during inspiration. [5][6][7][8][9] Theoretically, it simulates spontaneous breathing without the ETT, and appears to be suitable for use during the weaning period.…”

Section: Introductionmentioning

confidence: 99%

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

Oto

Imanaka

Nakataki³

et al. 2012

Respir Care

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BACKGROUND: Endotracheal tubes (ETTs) impose a substantial respiratory work load on mechanically ventilated patients. Automatic tube compensation (ATC) should overcome this flowdependent resistive work load; however, ETT resistance can be increased by tracheal secretions or ETT deformities. Our bench study investigated whether ATC provides effective respiratory work load relief in used ETTs. METHODS: We enrolled 20 critically ill patients requiring mechanical ventilation for longer than 48 hours. After extubation, we collected the used ETTs and measured the pressure-time products (PTPs) by using a bellows-in-a-box lung model that simulated spontaneous breathing, at a respiratory rate of 10 breaths/min, inspiratory time of 1.0 s, and tidal volumes (V T ) of 300 mL, 500 mL, and 700 mL. The ventilator was set at ATC 100% with PEEP of 5 cm H 2 O and F IO 2 of 0.21. The flow and airway pressure at the proximal (P aw ) and distal (P tr ) ends of the ETT were recorded, and the PTP integrated from P tr analyzed. RESULTS: PTP values increased with V T during ATC. Even at 100% ATC the ventilator did not completely compensate for the PTP imposed by the ETT. In used ETTs, peak flow and peak P aw were lower and PTP values were greater than in new ETTs. As V T increased, the percentage difference in the PTP values between the new and used ETTs increased. CONCLUSIONS: ATC does not necessarily compensate for an ETT-imposed respiratory work load. ETT configuration changes and tracheal secretions can increase ETT resistance and decrease the ability of ATC to compensate for the increased respiratory work load.

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Total versus tube‐related additional work of breathing in ventilator‐dependent patients

Abstract: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.

Cited by 58 publications

References 10 publications

Automatische Tubuskompensation (ATC)

Automatische Tubuskompensation (ATC)

Imposed Work of Breathing of Airway Adjuncts

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

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