Interactions of Closed Loop Control PEEP Oxygenation and Fluid Therapy
Abstract
Background: Closed loop control mechanical ventilation has been reported to potentially reduce ventilator weaning time, burden on medicalcaregivers, and improve comfort during mechanical ventilation. However, the influence of closed loop control PEEP adjustment, on fluid requirements in the acute phase and cardiopulmonary dysfunction, remains unknown. The aim of this study was to investigate the impact of closed loop ventilation and PEEP/FiO2 on decision support-based fluid resuscitation and respiratory mechanics/gas exchange using a clinically relevant ovine model of burn and smoke inhalation. Methods: Adult female sheep (31-42kg) were surgically prepared 5-7 days prior to the study. Sheep were then subjected to burn (3rd degree and 40 percent of body surface) and smoke inhalation injury under anesthesia and analgesia. During the injury, a pulse-oximeter was placed on the ear to monitor SpO2. After the injury, sheep were randomly assigned into control group (n=5) which received adaptive support ventilation (ASV) and closed loop group (n=6) which received ASV with Intellivent, using the Hamilton S1 ventilator. Sheep were monitored for 48 hours in a conscious state. In the control group, FiO2 and % Minute volume (%MV) were adjusted according to PaO2 and PaCO2 values measured every 3 6 hours. The PEEP was fixed at 5 cmH2O. In the Intellivent group, FiO2, PEEP, and %MV were automatically adjusted according to SpO2 and etCO2 changes. The initial fluid rate was 4 mL/kg for 1 h, then the rate was adjusted hourly based on an algorithm using the hourly urinary output. The survival rate, total fluid in, urine output, net fluid balance, severity of pulmonary dysfunction, and hemodynamic changes, were monitored. Results: All sheep survived in the closed loop group, while 2 out of 5 control group survived 48 hrs, p=0.06. Because only 2 sheep survived in the control group, the data was summarized for first 24hrs.
Document Details
- Document Type
- Technical Report
- Publication Date
- Sep 30, 2019
- Accession Number
- AD1089311
Entities
People
- Chris Blakeman
- Dario Rodriquez
- Ennert R. Manyeza
- Keibun Liu
- Michael Kinsky
- Michael Salter
- Muzna Khan
- Perenlei Enkhbaatar
- Rich Branson
- Satoshi Fukuda
- Yosuke Niimi
Organizations
- University of Cincinnati