Pre-Hospital & Aero-Medical Ventilation - Aeromed

David M Linton

Director: Medical Intensive Care

Department of Medicine

Hadassah Medical Organization

Jerusalem

AEROMED AFRICA 2012

Pre-Hospital & Aero-Medical Ventilation

The First ICU in Citation ZS-RCS

Newport E100m Ventilator

Oxygen and Air

“Adapt or die”

“Patients have to adapt to a

mechanical ventilator and its

physician-determined mode of

ventilation ! ”

Back to the Future

Adaptive Ventilation research at GSH

Adaptive Ventilation

Patient centered

Closed loop controlled

Adaptive Ventilation

Sophisticated yet simple to operate

Adaptive Ventilation

Varies according to the patient’s needs

Adaptive Ventilation is like an Auto -Pilot

Continuous use of an Adaptive Ventilation

controller in critically ill patients in a multi-

disciplinary Intensive Care Unit

David M Linton, Josef X Brunner, Thomas P Laubsher

S Afr Med J 1995; 85: 430 - 433

Continuous use of AV in ICU

Results:

AV selects appropriate P- SIMV pattern

mean pressure support level: 14,8 cm H20 (6 - 20 cm)

patients comfortable

arterial blood gasses within normal range

the AV controller allows early spontaneous effort,

reducing the level of pressure support

What about the landing (weaning ?)

Automatic Weaning From

Mechanical Ventilation Using an

Adaptive Ventilation Controller

David M Linton, Peter D Potgieter, Stanley

Davis, Anton Fourie et al:

Chest 1994; 106: 1843 - 50

Pressure support levels

Results

Automatic Weaning

Conclusions:

AV provides a safe, efficient wean

Responds immediately to inadequate

spontaneous ventilation

So, who’s the best ?

Comparison of SIMV and AV

28 patients

clinically selected SIMV

versus

automatically selected

SIMV vs AVResults:

In AV the mechanical rate dropped by an

average of 4 breaths per minute

AV tended to prevent rapid shallow breathing

Increased airway pressures in AV - with

increases in Vt and Vd

SIMV vs AV

SIMV ALV Mean diff.

Ti (sec) 1.6(0.4) 1.4 (0.5) 0.3 (0.4)*

Te (sec) 1.7 (0.6) 2.7 (1.0) 0.9 (1.1)*

Paw (cmH2O) 31.6 (10.5) 35.1 (12.2)

Ftot (b/min) 19.5 (6.3) 16.4 (6.8) 3.0 (6.1)*

Fmech 15 (6.4) 11.2 (7.0) 3.7 (6.4)*

Fspont 4.5 (6.4) 5.1 (8.7)

p < 0.05

Measurements

Flow Pressure

Doctor input

Target MV

FiO2

PEEP

Rate

S

E

L

E

C

T

O

R

Controller

Output

to Patient

SIMV

Ti

PSV

Lung FunctionAnalyzer Input

Rate

Volume

RR

Psup

RR

Psup

Adaptive Support Ventilation

No ventilator changes needed !

ASV adapts automatically to the need of the patient !

Full Partial Spontaneous

CMV SIMV CPAP

ASV

WOB Patient

WOB Ventilator

Adaptive Support Ventilation

• Earlier spontaneous effort

• Safe efficient weaning

• Reduced time on ventilation

Adaptive Support Ventilation

Closed-loop ventilation

like an auto-pilot

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