Study objective: To evaluate a new method of closed-loop mechanical ventilation using an adaptive lung ventilation (ALV) controller in patients with different pathologic causes of respiratory failure at a time when they first met standard weaning criteria.
Study design: Prospective, open, selected case study.
Setting: The 10-bed, multidisciplinary respiratory intensive care unit at Groote Schuur hospital, which is a teaching unit of the University of Cape Town.
Patients: Twenty-seven patients (9 patients in each of 3 groups: normal lungs, parenchymal lung disease, and COPD) who required prolonged mechanical ventilation and who met standard weaning criteria were included. Our institutional committee for ethical research approved the study and informed consent was obtained.
Interventions: The patients were mechanically ventilated and had daily measurements of vital capacity, respiratory rate, and arterial blood gas analysis until they met standard weaning criteria. On the day that each patient met the weaning criteria, a closed loop control algorithm providing ALV was implemented on a modified ventilator (Hamilton AMADEUS) with a PC-based lung function analyzer. After measuring gross alveolar ventilation, patients were placed in ALV and ventilatory and hemodynamic parameters were measured at baseline, 5 min, 30 min, and 2 h. Pertinent parameters measured included airway pressures, pressure support levels, respiratory rates, rapid shallow breathing indices, airway resistance indices, and patient respiratory drive and work indices.
Measurements and results: In 22 patients, ALV reduced pressure support to 5 cm H2O and an intermittent mandatory ventilation rate of 4 breaths/min within 30 min, and all but 1 of these patients were successfully extubated within 24 h. In four patients, pressure support was maintained by ALV at a mean level of 14.6 cm H2O +/- for 2 h and these patients were recorded as having failed to wean. There was a measurable difference in an index of airway resistance relative to muscular activity between the successfully weaned and failed wean patients with COPD during the attempted wean by the ALV controller.
Conclusions: ALV will provide a safe, efficient wean and will respond immediately to inadequate ventilation in patients when standard weaning criteria are met.