David M Linton Director: Medical Intensive Care Department of Medicine Hadassah Medical Organization Jerusalem AEROMED AFRICA 2012 Pre-Hospital & Aero-Medical Ventilation
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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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