Authors: Karel Roubik, Jakub Rafl, Marc van Heerde and Dick G. Markhorst
Citation
Roubík K, Ráfl J, van Heerde M, Markhorst DG. Design and Control of a Demand Flow System Assuring Spontaneous Breathing of a Patient Connected to an HFO Ventilator. IEEE Transaction on Biomedical Engineering 2011; 58(11); 3225-3233
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Published in IEEE Transactions on Biomedical Engineering
Abstract
Lung protective ventilation is intended to minimize the risk of ventilator induced lung injury and currently aimed at preservation of spontaneous breathing during mechanical ventilation. High-frequency oscillatory ventilation (HFOV) is a lung protective ventilation strategy. Commonly used high-frequency oscillatory (HFO) ventilators, SensorMedics 3100, were not designed to tolerate spontaneous breathing. Respiratory efforts in large pediatric and adult patients impose a high workload to the patient and may cause pressure swings that impede ventilator function. A Demand Flow System (DFS) was designed to facilitate spontaneous breathing during HFOV. Using a linear quadratic Gaussian state feedback controller, the DFS alters the inflow of gas into the ventilator circuit, so that it instantaneously compensates for the changes in mean airway pressure (MAP) in the ventilator circuit caused by spontaneous breathing. The undesired swings in MAP are thus eliminated. The DFS significantly reduces the imposed work of breathing and improves ventilator function. In a bench test the performance of the DFS was evaluated using a simulator ASL 5000.With the gas inflow controlled, MAP was returned to its preset value within 115 ms after the beginning of inspiration. The DFS might help to spread the use of HFOV in clinical practice.
Keywords
Demand Flow System, high-frequency oscillatory ventilation (HFOV), linear quadratic Gaussian (LQG) control, mechanical ventilation.
References
[1] L. N. Tremblay and A. S. Slutsky, “Ventilator-induced lung injury: From the bench to the bedside,” Intensive Care Med., vol. 32, no. 1, pp. 24–33, Jan. 2006.
[2] C. Putensen, T. Muders, D. Varelmann, and H. Wrigge, “The impact of spontaneous breathing during mechanical ventilation,” Curr. Opin. Crit. Care, vol. 12, no. 1, pp. 13–18, Feb. 2006.
[3] R. L. Chatburn, “Computer control of mechanical ventilation,” Respir. Care, vol. 49, no. 5, pp. 507–517, May 2004.
[4] P. Casaseca-de-la-Higuera, F. Simmross-Wattenberg, M. MartinFernandez, and C. Alberola-Lopez, “A multichannel model-based methodology for extubation readiness decision of patients on weaning trials,” IEEE Trans. Biomed. Eng., vol. 56, no. 7, pp. 1849–1863, Jul. 2009.
[5] F. C. Jandre, A. V. Pino, I. Lacorte, J. H. S. Neves, and A. Giannella-Neto, “A closed-loop mechanical ventilation controller with explicit objective functions,” IEEE Trans. Biomed. Eng., vol. 51, no. 5, pp. 823–831, May 2004.
[6] J. Pachl, K. Roubik, P. Waldauf, M. Fric, and V. Zabrodsky, “Normocapnic high-frequency oscillatory ventilation affects differently extrapulmonary and pulmonary forms of acute respiratory distress syndrome in adults,” Physiol. Res., vol. 55, no. 1, pp. 15–24, Feb. 2006.
[7] A. B. Froese, “High-frequency oscillatory ventilation for adult respiratory distress syndrome: Let’s get it right this time!,” Crit. Care Med., vol. 25, no. 6, pp. 906–908, Jun. 1997.
[8] C. N. Sessler, “Sedation, analgesia, and neuromuscular blockade for high-frequency oscillatory ventilation,” Crit. Care Med., vol. 33, no. 3, pp. S209–S216, Mar. 2005.
[9] M. van Heerde, H. R. van Genderingen, T. Leenhoven, K. Roubik, F. B. Plotz, and D. G. Markhorst, “Imposed work of breathing during highfrequency oscillatory ventilation: A bench study,” Crit. Care, vol. 10, no. 1, p. R23, Feb. 2006.
[10] H. E. Fessler, S. Derdak, N. D. Ferguson, D. N. Hager, R. M. Kacmarek, B. T. Thompson, and R. G. Brower, “A protocol for high-frequency oscillatory ventilation in adults: Results from a roundtable discussion,” Crit. Care Med., vol. 35, no. 7, pp. 1649–1654, Jul. 2007.
[11] M. van Heerde, K. Roubik, V. Kopelent, F. B. Plotz, and D. G. Markhorst, “Unloading work of breathing during high-frequency oscillatory ventilation: A bench study,” Crit. Care, vol. 10, no. 4, p. R103, Jul. 2006.
[12] V. Kopelent, “Artificial lung ventilation and its optimization,” Ph.D. dissertation, Dept. Radioelectronics, Faculty Elect. Eng., CTU in Prague, Prague, Czech Republic, 2007.
[13] K. J. Astrom and B. Wittenmark, Computer-Controlled Systems: Theory and Design, 3rd ed. Upper Saddle River, NJ: Prentice Hall, 1997.
[14] B. D. O. Anderson and J. B. Moore, Optimal Control: Linear Quadratic Methods. Mineola, NY: Dover Publications, 2007.
[15] D. Simon, Optimal State Estimation: Kalman, H Infinity, and Nonlinear Approaches. Hoboken, NJ: John Wiley and Sons, 2006.
[16] W. Yi, Q. Zhang, Y. Wang, and H. Qin, “Online noninvasive determination of patients and ventilator respiratory work during proportional assist ventilation,” in Proc. 2008 IEEE Int. Conf. Information and Automation, Zhangjiajie, China, pp. 1163–1167.
[17] M. Terado, S. Ichiba, O. Nagano, and Y. Ujike, “Evaluation of pressure support ventilation with seven different ventilators using Active Servo Lung 5000,” Acta Med. Okayama, vol. 62, no. 2, pp. 127–133, Apr. 2008.
[18] G. Jiao and J. W. Newhart, “Bench study on active exhalation valve performance,” Respir. Care, vol. 53, no. 12, pp. 1697–1702, Dec. 2008.
[19] E. Mireles-Cabodevila and R. L. Chatburn, “Work of breathing in adaptive pressure control continuous mandatory ventilation,” Respir. Care, vol. 54, no. 11, pp. 1467–1472, Nov. 2009.
[20] R. Matejka and K. Roubik, “Advanced monitoring system for conventional and high frequency ventilation,” Lekar a technika, vol. 38, no. 2, pp. 164–167, June 2008.
[21] A. W. Thille, A. Lyazidi, J.-C. M. Richard, F. Galia, and L. Brochard, “A bench study of intensive-care-unit ventilators: New versus old and turbine-based versus compressed gas-based ventilators,” Intensive Care Med., vol. 35, no. 8, pp. 1368–1376, Aug. 2009.
[22] M. van Heerde, K. Roubik, V. Kopelent, F. B. Plotz, and D. G. Markhorst, “Demand flow facilitates spontaneous breathing during high-frequency oscillatory ventilation in a pig model,” Crit. Care Med., vol. 37, no. 3, pp. 1068–1073, Mar. 2009.
[23] D. R. Gerstmann, J. M. Fouke, D. C. Winter, A. F. Taylor, and R. A. deLemos, “Proximal, tracheal, and alveolar pressures during high-frequency oscillatory ventilation in a normal rabbit model,” Pediatr. Res., vol. 28, no. 4, pp. 367–373, Oct. 1990.
[24] M. van Heerde, K. Roubik, V. Kopelent, M. C. J. Kneyber, and D. G. Markhorst, “Spontaneous breathing during high-frequency oscillatory ventilation improves regional lung characteristics in experimental lung injury,” Acta Anaesth. Scand., vol. 54, no. 10, pp. 1248–1256, Nov. 2010.
[25] P. C. Rimensberger, “Allowing for spontaneous breathing during highfrequency oscillation: The key for final success?,” Crit. Care, vol. 10, no. 4, p. 155, Jul. 2006.