S J Holt1, R C Sanders, T L Thurman, M J Heulitt. 1. Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, 800 Marshall Street, Little Rock AR 72202, USA.
Abstract
BACKGROUND: Weaning of mechanical ventilation in patients optimally includes meeting their needs by making frequent ventilator adjustments. The Siemens Servo 300A mechanical ventilator is designed to allow the ventilator to be interactive with the patient's needs by making breath-by-breath adjustments in both control and support modes. We undertook the following experiment to validate that the Automode algorithm responded appropriately using a pediatric animal model when apnea occurred and if there was any impact on work of breathing. METHODS: We ventilated 6 sedated spontaneously-breathing piglets using Automode in pressure-regulated volume control/volume support (PRVC/VS) mode, pressure control/pressure support (PC/PS) mode, and volume control/volume support (VC/VS) mode. Data were collected using both a computerized respiratory monitor and data acquisition system that recorded and analyzed individual animal breaths for response time, effort of triggering, and work of breathing. Data collection began with the animals breathing spontaneously in each support mode, followed by the administration of a short-acting neuromuscular blocker (succinylcholine) to induce apnea, thus allowing the ventilator to switch between modes automatically. Data collection was continued before, during, and after apnea to observe the duration of inspiratory effort, trigger response time, and any significant pressure or flow variances of the Automode feature. In addition, patient work of breathing (WOB(P)) and ventilator work of breathing (WOB(V)) were measured before and after each phase. RESULTS: We found no instances of failure of Automode to follow the predetermined algorithms. There was a difference in both the amount of change in pressure and most negative deflection of pressure by each animal during triggering in the post-paralysis phase (p < 0.05). Response time for individual breaths was shorter from initiation of breath to most negative deflection of pressure during the post-paralysis phase (p < 0.05). Maximum flow reached was lower in the post-paralysis phase for VC/VS and PC/PS (p < 0.05). We also found WOB(P) decreased and WOB(V) increased in the post-paralysis phase for all modes tested. CONCLUSIONS: The Automode algorithm performed as expected in this animal experiment. We conclude that differences in response time and negative deflection of pressure, as an indication of animal effort, and maximum flow reached were due to continued weakness from the neuro-muscular blocker. However, the ventilator continued to trigger despite decreased effort by the animal.
BACKGROUND: Weaning of mechanical ventilation in patients optimally includes meeting their needs by making frequent ventilator adjustments. The Siemens Servo 300A mechanical ventilator is designed to allow the ventilator to be interactive with the patient's needs by making breath-by-breath adjustments in both control and support modes. We undertook the following experiment to validate that the Automode algorithm responded appropriately using a pediatric animal model when apnea occurred and if there was any impact on work of breathing. METHODS: We ventilated 6 sedated spontaneously-breathing piglets using Automode in pressure-regulated volume control/volume support (PRVC/VS) mode, pressure control/pressure support (PC/PS) mode, and volume control/volume support (VC/VS) mode. Data were collected using both a computerized respiratory monitor and data acquisition system that recorded and analyzed individual animal breaths for response time, effort of triggering, and work of breathing. Data collection began with the animals breathing spontaneously in each support mode, followed by the administration of a short-acting neuromuscular blocker (succinylcholine) to induce apnea, thus allowing the ventilator to switch between modes automatically. Data collection was continued before, during, and after apnea to observe the duration of inspiratory effort, trigger response time, and any significant pressure or flow variances of the Automode feature. In addition, patient work of breathing (WOB(P)) and ventilator work of breathing (WOB(V)) were measured before and after each phase. RESULTS: We found no instances of failure of Automode to follow the predetermined algorithms. There was a difference in both the amount of change in pressure and most negative deflection of pressure by each animal during triggering in the post-paralysis phase (p < 0.05). Response time for individual breaths was shorter from initiation of breath to most negative deflection of pressure during the post-paralysis phase (p < 0.05). Maximum flow reached was lower in the post-paralysis phase for VC/VS and PC/PS (p < 0.05). We also found WOB(P) decreased and WOB(V) increased in the post-paralysis phase for all modes tested. CONCLUSIONS: The Automode algorithm performed as expected in this animal experiment. We conclude that differences in response time and negative deflection of pressure, as an indication of animal effort, and maximum flow reached were due to continued weakness from the neuro-muscular blocker. However, the ventilator continued to trigger despite decreased effort by the animal.