Towards Clinically Available Closed-loop Systems for Mechanical Ventilation in the Intensive Care Unit
07 March 2018 (online)
Objective To provide an overview of the state-of-the-art of closedloop systems in the field of mechanical ventilation.
Methods This survey is reviewing the literature and proposes an overview of existing closed-loop systems, in different areas of mechanical ventilation. It discusses the key points that guided their development and addresses specific issues such as their performance and penetration at the bedside.
Results Much research has been undertaken in the hope of improving patient-ventilator interaction and shortening the weaning process. This led to the development of new modes of ventilation and expert weaning systems that are starting to achieve a wider clinical audience.
Conclusion Intensive care unit personnel are facing increasing work load during care for patients with severe, multi-system illness, using sophisticated equipments that generate high information flows requiring quick processing. Mechanical ventilation is a good example of a process that requires skilful and timely management of multiple parameters that could be delegated to closed-loop systems. Availability of commercial offerings, validated by randomized controlled trials in a well-defined set of clinical situations, is starting to fulfill the promise of intelligent systems skillfully assisting caregivers at the bedside.
- 1 Sparkes DJ, Smith GB, Prytherch D. Intensive care requirements for an ageing population-a microcosm of problems facing the NHS?. Clin Med 2004; May-Jun; 04 (03) 263-6.
- 2 Heldt T, Long B, Verghese GC, Szolovits P, Mark RG. Integrating data, models, and reasoning in critical care. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Conference 2006; 01: 350-3.
- 3 Rolls KD, Elliott D. Using consensus methods to develop clinical practice guidelines for intensive care: the intensive care collaborative project. Aust Crit Care 2008; 21 (04) 200-15.
- 4 van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M. et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345 (19) 1359-67.
- 5 Odom J. Nursing shortage: impending doom or challenging opportunity?. J Perianesth Nurs 2000; 15 (05) 348-9.
- 6 Clifford GD, Long WJ, Moody GB, Szolovits P. Robust parameter extraction for decision support using multimodal intensive care data. Philosophical transactions Series A, Mathematical, physical, and engineering sciences 2009; 367 (1887): 411-29.
- 7 Clemmer TP. Computers in the ICU: where we started and where we are now. J Crit Care 2004; 19 (04) 201-7.
- 8 Fields AM, Fields KM, Cannon JW. Closed-loop systems for drug delivery. Curr Opin Anaesthesiol 2008; 21 (04) 446-51.
- 9 Greenwald I, Rosonoke S. Mechanical ventilation: understanding respiratory physiology & the basics of ventilator management. JEMS 2003; 28 (12) 74-86.
- 10 Saxton GA, Myers G. A servomechanism for automatic regulation of pulmonary ventilation. J Appl Physiol 1957; 11 (02) 326-8.
- 11 Burns SM. Pressure modes of mechanical ventilation: the good, the bad, and the ugly. AACN Adv Crit Care 2008; 19 (04) 399-411.
- 12 Tehrani F, Rogers M, Lo T, Malinowski T, Afuwape S, Lum M. et al. Closed-loop control if the inspired fraction of oxygen in mechanical ventilation. J Clin Monit Comput 2002; 17 (06) 367-76.
- 13 Tehrani F, Roum J. Flex: A New Computerized System for Mechanical Ventilation. J Clin Monit Comput 2008; 22 (02) 121-30.
- 14 Prinianakis G, Kondili E, Georgopoulos D. Patient-ventilator interaction: an overview. Respir Care Clin N Am 2005; 11 (02) 201-24.
- 15 Chatburn RL. Classification of ventilator modes: update and proposal for implementation. Respir Care 2007; 52 (03) 301-23.
- 16 Branson RD, Chatburn RL. Controversies in the critical care setting. Should adaptive pressure control modes be utilized for virtually all patients receiving mechanical ventilation? Respir Care 2007; 52 (04) 478-88.
- 17 Tehrani F. Adaptive support ventilation is a patented technology Intensive Care Med. 2008; 34 (12) 2306.
- 18 Wysocki M, Arnal J. Response to dr. Tehrani. Intensive Care Med. 2008; 34: 2307-8.
- 19 Laubscher TP, Heinrichs W, Weiler N, Hartmann G, Brunner JX. An adaptive lung ventilation controller. IEEE Trans Biomed Eng 1994; 41 (01) 51-9.
- 20 Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol 1950; 02 (11) 592-607.
- 21 Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology 2001; 95 (06) 1339-45.
- 22 Arnal JM, Wysocki M, Nafati C, Donati S, Granier I, Corno G. et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 2008; 34 (01) 75-81.
- 23 Younes M. Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 1992; 145 (01) 114-20.
- 24 Ambrosino N. Proportional assist ventilation (PAV): a significant advance or a futile struggle between logic and practice?. Thorax 2002; 57 (03) 272-6.
- 25 Younes M, Kun J, Masiowski B, Webster K, Roberts D. A method for noninvasive determination of inspiratory resistance during proportional assist ventilation. Am J Respir Crit Care Med 2001; 163 (04) 829-39.
- 26 Hewlett AM, Platt AS, Terry VG. Mandatory minute volume. A new concept in weaning from mechanical ventilation. Anaesthesia 1977; Feb; 32 (02) 163-9.
- 27 Davis S, Potgieter PD, Linton DM. Mandatory minute volume weaning in patients with pulmonary pathology. Anaesth Intensive Care 1989; May; 17 (02) 170-4.
- 28 Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 1994; 106 (04) 1188-93.
- 29 Torres A, Aznar R, Gatell JM, Jiménez P, González J, Ferrer A. et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142 (03) 523-8.
- 30 Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT. et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335 (25) 1864-9.
- 31 Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M. et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006; 174 (08) 894-900.
- 32 Rubenfeld GD. Implementing effective ventilator practice at the bedside. Curr Opin Crit Care 2004; 10 (01) 33-9.
- 33 Dojat M, Brochard L, Lemaire F, Harf A. A knowledge-based system for assisted ventilation of patients in intensive care units. Int J Clin Monit Comput 1992; 09 (04) 239-50.
- 34 Dojat M, Pachet F, Guessoum Z, Touchard D, Harf A, Brochard L. NéoGanesh: a working system for the automated control of assisted ventilation in ICUs. Artif Intell Med 1997; 11 (02) 97-117.
- 35 Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M. et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006; 174 (08) 894-900.
- 36 Wysocki M, Brunner J. Closed-Loop Ventilation: An Emerging Standard of Care?. Crit Care Clinics 2007; 23 (02) 223-40.
- 37 Wachter SB, Johnson K, Albert R, Syroid N, Drews F, Westenskow D. The evaluation of a pulmonary display to detect adverse respiratory events using high resolution human simulator. J Am Med Inform Assoc 2006; 13 (06) 635-42.