Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 81-93 , March 2009

Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare)

  • François Lellouche, MD, PhD (Doctor)

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de l'Hôpital Laval, Centre de Recherche de l'Hôpital Laval, 2725, chemin Sainte-Foy, G1V4G5, Québec, QC, Canada
    • Corresponding Author InformationCorresponding author. Tel.: +1 418 656 87 11x3298.
    • ,
  • Laurent Brochard, MD (Professor)

      Affiliations

    • Service de Réanimation Médicale, Hôpital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France

References 

  1. Chatburn RL. Computer control of mechanical ventilation. Respiratory Care. 2004 May;49(5):507–517
  2. Brochard L, Lellouche F. Pressure support ventilation. In:  Tobin MJ editors. Principles of mechanical ventilation. 2nd edn.. New York: McGraw –Hill; 2006;
  3. Wysocki M, Brunner JX. Closed-loop ventilation: an emerging standard of care?. Critical Care Clinics. 2007 Apr;23(2):223–240ix
  4. Branson RD, Johannigman JA. What is the evidence base for the newer ventilation modes?. Respiratory Care. 2004 Jul;49(7):742–760
  5. Branson RD. Dual control modes, closed loop ventilation, handguns, and tequila. Respiratory Care. 2001 Mar;46(3):232–233
  6. Jaber S, Delay JM, Matecki S, et al. Volume-guaranteed pressure-support ventilation facing acute changes in ventilatory demand. Intensive Care Medicine. 2005 Sep;31(9):1181–1188
  7. Sottiaux TM. Patient-ventilator interactions during volume-support ventilation: asynchrony and tidal volume instability – a report of three cases. Respiratory Care. 2001 Mar;46(3):255–262
  8. Younes M. Proportional assist ventilation. In:  Tobin MJ editors. Principles and practice of mechanical ventilation. New York: McGraw-Hill; 1994;p. 349–369
  9. Younes M, Puddy A, Roberts D, et al. Proportional assist ventilation. Results of an initial clinical trial. American Review of Respiratory Disease. 1992;145:121–129
  10. Sinderby C, Navalesi P, Beck J, et al. Neural control of mechanical ventilation in respiratory failure. Natural Medicines. 1999 Dec;5(12):1433–1436
  11. Sinderby C, Beck J. Proportional assist ventilation and neurally adjusted ventilatory assist – better approaches to patient ventilator synchrony?. Clinics in Chest Medicine. 2008 Jun;29(2):329–342vii
  12. Laubscher TP, Heinrichs W, Weiler N, et al. An adaptive lung ventilation controller. IEEE Transactions on Bio-medical Engineering. 1994 Jan;41(1):51–59
  13. Dojat M, Brochard L, Lemaire F, Harf A. A knowledge-based system for assisted ventilation of patients in intensive care units. International Journal of Clinical Monitoring and Computing. 1992 Dec;9(4):239–250
  14. Bouadma L, Lellouche F, Cabello B, et al. Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study. Intensive Care Medicine. 2005 Oct;31(10):1446–1450
  15. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. American Journal of Respiratory and Critical Care Medicine. 2006 Oct 15;174(8):894–900
  16. Mancebo J. Assist control ventilation. In:  Tobin MJ editors. Principles of Mechanical Ventilation. 2nd edn.. New York: McGraw–Hill; 2006;
  17. Pronovost PJ, Angus DC, Dorman T, et al. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA : The Journal of the American Medical Association. 2002 Nov 6;288(17):2151–2162
  18. Dang D, Johantgen ME, Pronovost PJ, Jenckes MW, Bass EB. Postoperative complications: does intensive care unit staff nursing make a difference?. Heart Lung. 2002 May-Jun;(3):219–228
  19. Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ. Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet. 2000 Jul 15;356(9225):185–189
  20. Thorens JB, Kaelin RM, Jolliet P, Chevrolet JC. Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Critical Care Medicine. 1995 Nov;23(11):1807–1815
  21. Amaravadi RK, Dimick JB, Pronovost PJ, Lipsett PA. ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Medicine. 2000 Dec;26(12):1857–1862
  22. Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient. 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 : The Journal of the American Medical Association. 2000 Dec 6;284(21):2762–2770
  23. Needham DM, Bronskill SE, Calinawan JR, et al. Projected incidence of mechanical ventilation in Ontario to 2026: preparing for the aging baby boomers. Critical Care Medicine. 2005 Mar;33(3):574–579
  24. Zilberberg MD, de Wit M, Pirone JR, Shorr AF. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Critical Care Medicine. 2008 May;36(5):1451–1455
  25. Needham DM, Bronskill SE, Sibbald WJ, et al. Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients. Critical Care Medicine. 2004 Jul;32(7):1504–1509
  26. Cox CE, Carson SS, Govert JA, et al. An economic evaluation of prolonged mechanical ventilation. Critical Care Medicine. 2007 Aug;35(8):1918–1927
  27. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical Care Medicine. 2005 Jun;33(6):1266–1271
  28. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. European Respiratory Journal. 2007 May;29(5):1033–1056
  29. Boyle D, O'Connell D, Platt FW, Albert RK. Disclosing errors and adverse events in the intensive care unit. Critical Care Medicine. 2006 May;34(5):1532–1537
  30. Giraud T, Dhainaut JF, Vaxelaire JF, et al. Iatrogenic complications in adult intensive care units: a prospective two-center study. Critical Care Medicine. 1993 Jan;21(1):40–51
  31. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. The New England Journal of Medicine. 2004 Oct 28;351(18):1838–1848
  32. Moyen E, Camire E, Stelfox HT. Clinical review: medication errors in critical care. Critical Care (London, England). 2008 Mar 12;12(2):208
  33. Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Critical Care Medicine. 1995 Feb;23(2):294–300
  34. Baldwin DC, Daugherty SR, Tsai R, Scotti MJ. A national survey of residents' self-reported work hours: thinking beyond specialty. Academic Medicine. 2003 Nov;78(11):1154–1163
  35. Saravolatz LD, Pohlod DJ, Conway W, et al. Lack of bacterial aerosols associated with heat and moisture exchangers. American Review of Respiratory Disease. 1986;134(2):214–216
  36. Scott LD, Hwang WT, Rogers AE. The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses. The Journal of Nursing Administration. 2006 Feb;36(2):86–95
  37. Scott LD, Rogers AE, Hwang WT, Zhang Y. Effects of critical care nurses' work hours on vigilance and patients' safety. American Journal of Critical Care. 2006 Jan;15(1):30–37
  38. Donchin Y, Seagull FJ. The hostile environment of the intensive care unit. Current Opinion in Critical Care. 2002 Aug;8(4):316–320
  39. Embriaco N, Papazian L, Kentish-Barnes N, et al. Burnout syndrome among critical care healthcare workers. Current Opinion in Critical Care. 2007 Oct;13(5):482–488
  40. Poncet MC, Toullic P, Papazian L, et al. Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine. 2007 Apr 1;175(7):698–704
  41. Verdon M, Merlani P, Perneger T, Ricou B. Burnout in a surgical ICU team. Intensive Care Medicine. 2008 Jan;34(1):152–156
  42. Lenfant C. Shattuck lecture – clinical research to clinical practice – lost in translation?. The New England Journal of Medicine. 2003 Aug 28;349(9):868–874
  43. Westfall JM, Mold J, Fagnan L. Practice-based research – ‘Blue Highways’ on the NIH roadmap. JAMA: The Journal of the American Medical Association. 2007 Jan 24;297(4):403–406
  44. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. The New England Journal of Medicine. 2003 Jun 26;348(26):2635–2645
  45. Pronovost PJ, Rinke ML, Emery K, et al. Interventions to reduce mortality among patients treated in intensive care units. Journal of Critical Care. 2004 Sep;19(3):158–164
  46. Medicine Io. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C: National Academy Press; 2001;
  47. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA : The Journal of the American Medical Association. 1999 Oct 20;282(15):1458–1465
  48. Gravel K, Legare F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implementation Science. 2006;1:16
  49. Dent EB, Galloway Goldberg S. Challenging resistance to change. The Journal of Applied Behavioral Science. 1999;35:25–41
  50. Rubenfeld GD, Cooper C, Carter G, et al. Barriers to providing lung-protective ventilation to patients with acute lung injury. Critical Care Medicine. 2004 Jun;32(6):1289–1293
  51. Rubenfeld GD. Implementing effective ventilator practice at the bedside. Current Opinion in Critical Care. 2004 Feb;10(1):33–39
  52. Sinuff T, Cook D, Giacomini M, et al. Facilitating clinician adherence to guidelines in the intensive care unit: A multicenter, qualitative study. Critical Care Medicine. 2007 Sep;35(9):2083–2089
  53. Dojat M, Harf A, Touchard D, et al. Evaluation of a knowledge-based system providing ventilatory management and decision for extubation. American Journal of Respiratory and Critical Care Medicine. 1996 Mar;153(3):997–1004
  54. Cox CE, Carson SS, Ely EW, et al. Effectiveness of medical resident education in mechanical ventilation. American Journal of Respiratory and Critical Care Medicine. 2003 Jan 1;167(1):32–38
  55. Young MP, Manning HL, Wilson DL, et al. Ventilation of patients with acute lung injury and acute respiratory distress syndrome: has new evidence changed clinical practice?. Critical Care Medicine. 2004 Jun;32(6):1260–1265
  56. Weinert CR, Gross CR, Marinelli WA. Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals. American Journal of Respiratory and Critical Care Medicine. 2003 May 15;167(10):1304–1309
  57. Kalhan R, Mikkelsen M, Dedhiya P, et al. Underuse of lung protective ventilation: analysis of potential factors to explain physician behavior. Critical Care Medicine. 2006 Feb;34(2):300–306
  58. Ferguson ND, Frutos-Vivar F, Esteban A, et al. Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. Critical Care Medicine. 2005 Jan;33(1):21–30
  59. Ely EW. Challenges encountered in changing physicians' practice styles: the ventilator weaning experience. Intensive Care Medicine. 1998 Jun;24(6):539–541
  60. Ely EW, Bennett PA, Bowton DL, et al. Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. American Journal of Respiratory and Critical Care Medicine. 1999 Feb;159(2):439–446
  61. Vitacca M, Clini E, Porta R, Ambrosino N. Preliminary results on nursing workload in a dedicated weaning center. Intensive Care Medicine. 2000 Jun;26(6):796–799
  62. Umoh NJ, Fan E, Mendez-Tellez PA, et al. Patient and intensive care unit organizational factors associated with low tidal volume ventilation in acute lung injury. Critical Care Medicine. 2008 May;36(5):1463–1468
  63. Saxton GA, Myers G. A servomechanism for automatic regulation of pulmonary ventilation. Journal of Applied Physiology. 1957 Sep;11(2):326–328
  64. East TD, Bohm SH, Wallace CJ, et al. A successful computerized protocol for clinical management of pressure control inverse ratio ventilation in ARDS patients. Chest. 1992 Mar;101(3):697–710
  65. East TD, Heermann LK, Bradshaw RL, et al. Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial. Proceedings/AMIA Annual Symposium. 1999;251–255
  66. Morris AH. Developing and implementing computerized protocols for standardization of clinical decisions. Annals of Internal Medicine. 2000 Mar 7;132(5):373–383
  67. Tehrani FT. A new decision support system for mechanical ventilation. Engineering in Medicine and Biology Society, 2007. EMBS 2007. 29th Annual International Conference of the IEEE, 22-26 Aug. 2007; 3569--3572. doi:10.1109/IEMBS.2007.4353102.
  68. Chopin C, Chambrin MC, Mangalaboyi J, et al. Computerized monitoring system for mechanical ventilation. Description and initial results, Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression. 1980;21(B):93–100
  69. Samodelov LF, Falke KJ. Total inspiratory work with modern demand valve devices compared to continuous flow CPAP. Intensive Care Medicine. 1988;14:632–639
  70. Strickland JH, Hasson JH. A computer-controlled ventilator weaning system. Chest. 1991;100:1096–1099
  71. Strickland JH, Hasson JH. A computer-controlled ventilator weaning system. Chest. 1993;103:1220–1226
  72. Mitamura Y, Mikami T, Yamamoto K. A dual control system for assisting respiration. Medical & biological engineering. 1975 Nov;13(6):846–853
  73. Nemoto T, Hatzakis GE, Thorpe CW, et al. Automatic control of pressure support mechanical ventilation using fuzzy logic. American Journal of Respiratory and Critical Care Medicine. 1999 Aug;160(2):550–556
  74. Tehrani F, Rogers M, Lo T, et al. A dual closed-loop control system for mechanical ventilation. Journal of Clinical Monitoring and Computing. 2004 Apr;18(2):111–129
  75. Tehrani FT, Roum JH. Flex: a new computerized system for mechanical ventilation. Journal of Clinical Monitoring and Computing. 2008 Apr;22(2):121–130
  76. Dojat M, Sayettat C. A realistic model for temporal reasoning in real-time patient monitoring. Applied Artificial Intelligence. 1996;121–143
  77. Dojat M, Harf A, Touchard D, et al. Clinical evaluation of a computer-controlled pressure support mode. American Journal of Respiratory and Critical Care Medicine. 2000 Apr;161(4 Pt 1):1161–1166
  78. Younes M. Proportional assist ventilation and pressure support ventilation; similarities and differences. Update in Intensive Care and Emergency Medicine. 1991;15:361–380
  79. Ranieri VM, Giuliani R, Mascia L, et al. Patient-ventilator interaction during acute hypercapnia: pressure-support vs. proportional-assist ventilation. Journal of Applied Physiology. 1996 Jul;81(1):426–436
  80. Mols G, von Ungern-Sternberg B, Rohr E, et al. Respiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance. Critical Care Medicine. 2000 Jun;28(6):1940–1946
  81. Wrigge H, Golisch W, Zinserling J, et al. Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease. Intensive Care Medicine. 1999 Aug;25(8):790–798
  82. Wysocki M, Meshaka P, Richard JC, Similowski T. Proportional-assist ventilation compared with pressure-support ventilation during exercise in volunteers with external thoracic restriction. Critical Care Medicine. 2004 Feb;32(2):409–414
  83. Bosma K, Ferreyra G, Ambrogio C, et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Critical Care Medicine. 2007 Apr;35(4):1048–1054
  84. Porta R, Appendini L, Vitacca M, et al. Mask proportional assist vs pressure support ventilation in patients in clinically stable condition with chronic ventilatory failure. Chest. 2002 Aug;122(2):479–488
  85. Younes M, Kun J, Masiowski B, et al. A method for noninvasive determination of inspiratory resistance during proportional assist ventilation. American Journal of Respiratory and Critical Care Medicine. 2001 Mar;163(4):829–839
  86. Younes M, Webster K, Kun J, et al. A method for measuring passive elastance during proportional assist ventilation. American Journal of Respiratory and Critical Care Medicine. 2001 Jul 1;164(1):50–60
  87. Kondili E, Prinianakis G, Alexopoulou C, et al. Respiratory load compensation during mechanical ventilation-proportional assist ventilation with load-adjustable gain factors versus pressure support. Intensive Care Medicine. 2006 May;32(5):692–699
  88. Fernandez-Vivas M, Caturla-Such J, Gonzalez de la Rosa J, et al. Noninvasive pressure support versus proportional assist ventilation in acute respiratory failure. Intensive Care Medicine. 2003 Jul;29(7):1126–1133
  89. Gay PC, Hess DR, Hill NS. Noninvasive proportional assist ventilation for acute respiratory insufficiency. Comparison with pressure support ventilation. American Journal of Respiratory and Critical Care Medicine. 2001 Nov 1;164(9):1606–1611
  90. Brochard L. Intrinsic (or auto-) positive end-expiratory pressure during spontaneous or assisted ventilation. Intensive Care Medicine. 2002 Nov;28(11):1552–1554
  91. Aslanian P, El Atrous S, Isabey D, et al. Effects of flow triggering on breathing effort during partial ventilatory support. American Journal of Respiratory and Critical Care Medicine. 1998 Jan;157(1):135–143
  92. Calderini E, Confalonieri M, Puccio PG, et al. Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Medicine. 1999 Jul;25(7):662–667
  93. Spahija J, Beck J, de Marchie M, et al. Closed-loop control of respiratory drive using pressure-support ventilation: target drive ventilation. American Journal of Respiratory and Critical Care Medicine. 2005 May 1;171(9):1009–1014
  94. Sinderby C, Beck J, Spahija J, et al. Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest. 2007 Mar;131(3):711–717
  95. Moerer O, Beck J, Brander L, et al. Subject–ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Medicine. 2008 Sep;34(9):1615–1623
  96. Allo JC, Beck JC, Brander L, et al. Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Critical Care Medicine. 2006 Dec;34(12):2997–3004
  97. Beck J, Campoccia F, Allo JC, et al. Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatric Research. 2007 Mar;61(3):289–294
  98. Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. Journal of Applied Physiology. 1950 May;2(11):592–607
  99. Mead J. Control of respiratory frequency. Journal of Applied Physiology. 1960;15:325–336
  100. Knoben JE, Anderson PO. Handbook of clinical drug data, 7th edn. Hamilton, Ill 1993.
  101. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. The New England Journal of Medicine. 2000 May 4;342(18):1301–1308
  102. Arnal JM, Wysocki M, Nafati C, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Medicine. 2008 Jan;34(1):75–81
  103. Cassina T, Chiolero R, Mauri R, Revelly JP. Clinical experience with adaptive support ventilation for fast-track cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2003 Oct;17(5):571–575
  104. Petter AH, Chiolero RL, Cassina T, et al. Automatic ‘respirator/weaning’ with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesthesia and Analgesia. 2003 Dec;97(6):1743–1750
  105. Sulzer CF, Chiolero R, Chassot PG, et al. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001 Dec;95(6):1339–1345
  106. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Critical Care Medicine. 2002 Apr;30(4):801–807
  107. Branson RD, Davis K. Does closed loop control of assist control ventilation reduce ventilator-induced lung injury?. Clinics in Chest Medicine. 2008 Jun;29(2):343–350viii

PII: S1521-6896(08)00081-5

doi: 10.1016/j.bpa.2008.08.001

Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 81-93 , March 2009

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