Closed-loop mechanical ventilation for lung injury: a novel physiological-feedback mode following the principles of the open lung concept

• Published in: Journal of clinical monitoring and computing Vol. 32; no. 3; pp. 493 - 502
• Main Authors: Schwaiberger, David, Pickerodt, Philipp A., Pomprapa, Anake, Tjarks, Onno, Kork, Felix, Boemke, Willehad, Francis, Roland C. E., Leonhardt, Steffen, Lachmann, Burkhard
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.06.2018; Springer Nature B.V
• Subjects: Algorithms; Anesthesiology; Animals; Atelectasis; Computer Systems; Critical Care Medicine; Electric Impedance; Electrical impedance; Feasibility; Feedback; Gas exchange; Health Sciences; Injuries; Intensive; Lung; Lung Injury - therapy; Medicine; Medicine & Public Health; Monitoring, Physiologic - methods; Original Research; Oxygenation; Physiological responses; Physiology; Positive-Pressure Respiration - methods; Pulmonary Gas Exchange; Respiration; Respiration, Artificial - methods; Respiratory therapy; Statistics for Life Sciences; Surface-Active Agents; Swine; Tidal energy; Tidal power; Tidal Volume; Tomography - methods; Ventilation; Acute respiratory distress syndrome; Electrical impedance tomography; Closed-loop mechanical ventilation; Lung protective ventilation; Open lung approach
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-017-0040-0

Adherence to low tidal volume (V T ) ventilation and selected positive end-expiratory pressures are low during mechanical ventilation for treatment of the acute respiratory distress syndrome. Using a pig model of severe lung injury, we tested the feasibility and physiological responses to a novel fully closed-loop mechanical ventilation algorithm based on the “open lung” concept. Lung injury was induced by surfactant washout in pigs (n = 8). Animals were ventilated following the principles of the “open lung approach” (OLA) using a fully closed-loop physiological feedback algorithm for mechanical ventilation. Standard gas exchange, respiratory- and hemodynamic parameters were measured. Electrical impedance tomography was used to quantify regional ventilation distribution during mechanical ventilation. Automatized mechanical ventilation provided strict adherence to low V T -ventilation for 6 h in severely lung injured pigs. Using the “open lung” approach, tidal volume delivery required low lung distending pressures, increased recruitment and ventilation of dorsal lung regions and improved arterial blood oxygenation. Physiological feedback closed-loop mechanical ventilation according to the principles of the open lung concept is feasible and provides low tidal volume ventilation without human intervention. Of importance, the “open lung approach”-ventilation improved gas exchange and reduced lung driving pressures by opening atelectasis and shifting of ventilation to dorsal lung regions.