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HAMILTON-G5/S1. La solución de ventilación modular de alta gama

Respiradores HAMILTON-G5/-S1 Respiradores HAMILTON-G5/-S1

Una para todos. Completa y polivalente

En la unidad de cuidados intensivos, los respiradores HAMILTON-G5 y HAMILTON-S1 son un aliado en el que puede confiar para todas las poblaciones de pacientes, desde neonatos hasta adultos. Gracias a su multitud de características avanzadas, puede utilizarse con pacientes con todo tipo de necesidades de ventilación, desde terapia con flujo alto de oxígeno hasta ventilación invasiva. Y, llegado el momento, los modos avanzados como INTELLiVENT-ASV pueden ayudarle incluso a retirarlos gradualmente del respirador (Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care. 2021;61:191-198. doi:10.1016/j.jcrc.2020.10.0251).

Ilustración gráfica: pulmón humano con el símbolo de un "escudo de protección" como signo de protección pulmonar

Tal como lo necesite. Terapia individualizada para sus pacientes

Con la amplia gama de características opcionales del HAMILTON-G5, puede crear su propia solución personalizada para ofrecer una ventilación con protección pulmonar individualizada a sus pacientes:

  • Modos de ventilación inteligente
  • Evaluación y reclutamiento pulmonar
  • Sincronización basada en el análisis de las formas de onda
  • Medición de la presión transpulmonar
Un especialista maneja un HAMILTON-S1

Al alcance de la vista. Acceso remoto a los controles y el estado del humidificador

La exclusiva opción de conectividad del respirador le permite utilizar el humidificador HAMILTON-H900 directamente desde la pantalla del respirador. Puede acceder a todos los controles, parámetros de monitorización y alarmas, y ajustarlos según sea necesario.

El humidificador también puede elegir automáticamente el modo de humidificación (invasiva, no invasiva o de flujo alto) en función del modo de ventilación seleccionado.

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  • Estándar
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Grupos de pacientes Adulto/Ped., Neonatal
Dimensiones (ancho x largo x alto) 500 x 450 x 440 mm (unidad de ventilación)
580 x 600 x 1300 mm (mín., monitor montado en raíl)
580 x 600 x 1500 mm (máx., monitor montado en raíl)
Peso Unidad de ventilación, monitor y montaje en repisa: 38 kg
57 kg con carro, monitor y unidad de ventilación de serie
Resolución y tamaño del monitor 381 mm, diagonal
1024 x 768 píxeles
Monitor desmontable
Tiempo de funcionamiento de la batería 1 h con una batería
Batería intercambiable en funcionamiento
Suministro de aire Requiere aire comprimido
Conector O2 DISS (CGA 1240) o NIST (opcional), NF (opcional)
Conectividad CompactFlash, USB, DVI, COM (RS-232), interfaz especial
Volumen 38,6 dB en funcionamiento normal
Control por flujo y por volumen
Volumen objetivo, control por presión adaptable
Ventilación inteligente ASV®, INTELLiVENT®-ASV® (opcional en HAMILTON-G5, de serie en HAMILTON-S1)
Ventilación no invasiva
Flujo alto
Visualización de la mecánica pulmonar (Pulm. dinámico)
Visualización de la dependencia del respirador del paciente
Medición de la presión esofágica
Capnograma
Monitorización de SpO2
Evaluación de reclutamiento y reclutamiento pulmonar (P/V Tool Pro)
Sincronización paciente-respirador (IntelliSync+)
Ventilación de RCP
Módulo Hamilton Connect
Aplicación Hamilton Connect
Conexión remota al humidificador HAMILTON-H900
Controlador de la presión del manguito IntelliCuff integrado
Nebulizador neumático integrado
Nebulizador Aerogen integrado
Compatibilidad con el sistema de administración de anestésicos Sedaconda ACD-S
Craig Jolly Bimari Treuren

Testimonios de clientes

Lo que más me gusta del HAMILTON-G5 son los parámetros de monitorización y la capacidad de generar con ellos tendencias en tiempo real de hasta 72 horas. Lo he usado para distintas enfermedades y para generar datos de tendencias que antes me eran impensables.

Craig Jolly

Fisioterapeuta respiratorio titulado, coordinador del departamento de Educación clínica para adultos
University Medical Center, Lubbock (TX), EE. UU.

Testimonios de clientes

El HAMILTON-G5 nos ha proporcionado múltiples opciones y funciones distintas, todas ellas muy necesarias en la UCI neonatal.

Bimari Treuren

Supervisora médica de terapia respiratoria
Florida Hospital for Children, Orlando (FL), EE. UU.

Para sus pacientes

Soluciones de ventilación inteligente de un vistazo

ASV®: Adaptive Support Ventilation®. Para la adaptación constante del suministro

El modo de ventilación ASV ajusta de forma continua la frecuencia respiratoria, el volumen tidal y el tiempo inspiratorio respiración a respiración en función de la mecánica pulmonar y los esfuerzos del paciente las 24 horas del día, desde la intubación hasta la extubación.

INTELLiVENT®-ASV®. Para la asistencia a pie de cama

El modo de ventilación inteligente INTELLiVENT-ASV controla continuamente la ventilación y la oxigenación del paciente.

Define la ventilación por minuto, así como los valores de PEEP y de oxigenación en función de los objetivos fijados por el médico y los datos fisiológicos del paciente.

IntelliSync®+. Para la sincronización entre paciente y respirador

Gracias al continuo análisis de las formas de onda cientos de veces por segundo, IntelliSync+ permite detectar los esfuerzos del paciente y realiza ciclos inmediatamente para iniciar la inspiración y la espiración en tiempo real.

IntelliSync+ se aplica a la ventilación invasiva y no invasiva con independencia del modo de ventilación.

P/V Tool® Pro. Para evaluación y reclutamiento pulmonar

Puede utilizar P/V Tool Pro para evaluar la capacidad de reclutamiento pulmonar y determinar la estrategia de reclutamiento.

Por otro lado, también puede usarse para llevar a cabo una maniobra de reclutamiento de inspiración mantenida y para medir el aumento del volumen pulmonar.

Medición de la presión transpulmonar. Para datos obtenidos desde el interior

La medición de la presión transpulmonar permite optimizar el valor de PEEP, el volumen tidal y la presión inspiratoria.

Se usa junto con P/V Tool Pro para valorar la capacidad de reclutamiento pulmonar y realizar maniobras de reclutamiento.

Acceso remoto al humidificador. Para su comodidad

La exclusiva opción de conectividad del respirador le permite utilizar el humidificador HAMILTON-H900 (El HAMILTON-H900 no está aprobado para su uso durante traslados.e) directamente desde la pantalla del respirador. Puede acceder a todos los controles, parámetros de monitorización y alarmas, y ajustarlos según sea necesario.

El humidificador también puede elegir automáticamente el modo de humidificación (invasiva, no invasiva o de flujo alto) en función del modo de ventilación seleccionado.

Nebulizador integrado. Para tratamientos adicionales

El nebulizador neumático integrado está totalmente sincronizado con los tiempos de inspiración y espiración.

Un nebulizador Aerogen integrado y sincronizado está disponible opcionalmente (No disponible en todos los mercadosa, Solo disponible para HAMILTON-C6/G5/S1b).

El suministro de una ligera nube de partículas medicamentosas en aerosol le ayuda a revertir el broncoespasmo, mejorar la eficiencia de la ventilación y reducir la hipercapnia (Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677. 100, Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815101).

IntelliCuff® integrado. Para la presión del manguito controlada

IntelliCuff mide constantemente y conserva de manera automática la presión en el manguito del tubo endotraqueal y del tubo de traqueotomía que haya establecido el usuario en tiempo real (El modo Auto de IntelliCuff no está disponible en todos los mercados.c).

Terapia de cánulas nasales de flujo alto. Para fanáticos del O2

La terapia de cánulas nasales de flujo alto está disponible como opción en todos nuestros respiradores. Con solo unos pasos, podrá cambiar la interfaz y usar el mismo dispositivo y circuito respiratorio para adaptarse a las necesidades terapéuticas del paciente.

Capnografía volumétrica. Para Co2ntrol Freaks

La medición del flujo proximal y del CO2 permite a nuestros respiradores realizar novedosas capnografías volumétricas, lo cual es fundamental para la valoración de la calidad de la ventilación y la actividad metabólica.

Panel Estado ventil. Para aquellos listos para el destete

En el panel Estado ventil., aparecen seis parámetros relacionados con la dependencia del paciente del respirador, incluidas la oxigenación, la eliminación de CO2 y la actividad del paciente.

Un indicador flotante se mueve hacia arriba y hacia abajo en cada columna para mostrar el valor actual de un parámetro determinado.

Destete rápido Para los independientes

La función Destete rápido está integrada en el modo INTELLiVENT-ASV y proporciona monitorización y control del estado del paciente de manera dinámica y continua para evaluar si el paciente está preparado para la extubación.

SBT automáticas. Para los espontáneos

Las pruebas de respiración espontánea (SBT) automatizadas forman parte de la función Destete rápido del modo INTELLiVENT-ASV y le ofrecen la opción de realizar SBT totalmente controladas.

Panel Pulm. dinámico. Para personas con perspectiva visual

El panel Pulm. dinámico muestra una representación gráfica en tiempo real de los siguientes datos de monitorización importantes en:

  • Volumen tidal
  • Compliance y resistencia
  • Activación por parte del paciente
  • SpO2
  • Frecuencia de pulso

Bucles y tendencias configurables. Para estadísticos

El respirador puede mostrar un bucle dinámico en función de una combinación seleccionada de parámetros monitorizados. Con la función Tendencias, puede ver la información de tendencias que se muestra para los parámetros de monitorización durante el tiempo que usted seleccione. 

El dispositivo almacena continuamente los parámetros monitorizados en su memoria, incluso cuando está en Standby.

Pulsioximetría. Para entusiastas de la SpO2

La opción SpO2 ofrece una medición de SpO2 no invasiva integrada y muestra los datos en el respirador para que pueda analizarlos cómodamente.

También ofrecemos una completa gama de sensores de SpO2.

Ventilación no invasiva de alto rendimiento. Para los que llevan mascarilla

Los modos de ventilación no invasiva ofrecen respiraciones espontáneas con ciclos de flujo y presión de soporte (modos NIV y NIV-ST) y respiraciones obligatorias cicladas por tiempo y controladas por presión (NIV-ST).

En comparación con los respiradores que utilizan aire comprimido, nuestros respiradores accionados por turbina son capaces de proporcionar flujos máximos elevados, lo que garantiza un rendimiento óptimo incluso con fugas importantes.

Modos nCPAP. Para los más pequeños

Los modos nCPAP están diseñados de tal manera que solo tendrá que fijar la presión CPAP que desee. y, a continuación, se ajustará el flujo en función del estado del paciente y las posibles fugas. Así se evitan presiones máximas involuntarias, se garantiza una compensación eficaz de las fugas y se ayuda a reducir el consumo de oxígeno. El ajuste del flujo se lleva a cabo casi inmediatamente gracias a que la medición es altamente sensible.

Terapia con heliox. Para las vías aéreas obstruidas

La terapia con heliox puede ayudarle a reducir con éxito el esfuerzo respiratorio del paciente mientras trata la causa de la obstrucción de las vías aéreas superiores (Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD. The history and physics of heliox. Respir Care. 2006;51(6):608-612. 102, Berkenbosch JW, Grueber RE, Graff GR, Tobias JD. Patterns of helium-oxygen (heliox) usage in the critical care environment. J Intensive Care Med. 2004;19(6):335-344. doi:10.1177/0885066604269670103).

Para usted

Equipo respiratorio coaxial

Montado. Listo para usar

Nuestros equipos respiratorios montados incluyen el material fungible esencial para utilizar el respirador, cómodamente empaquetado en una única bolsa.

Todo nuestro material fungible esencial se ha desarrollado especialmente para los respiradores de Hamilton Medical con garantía de calidad del fabricante.

Automatización; una mano girando un pulsador en el sentido de las agujas del reloj

Menos pulsadores que girar. Más adaptaciones para los pacientes

Para gestionar la ventilación, suele ser necesario configurar diversos parámetros, como la presión, el volumen, el disparo espiratorio e inspiratorio y la presión de manguito, entre muchos otros. Cada vez que cambia el estado del paciente, hay que realizar uno o incluso varios reajustes.

Para simplificar este proceso y reducir el uso de los pulsadores, hemos creado toda una gama de soluciones:

La ventilación asistida adaptable (ASV) es un modo de ventilación que adapta de forma continua la frecuencia respiratoria, el volumen tidal y el tiempo inspiratorio en función de la mecánica pulmonar y el esfuerzo del paciente. Se ha demostrado que ASV reduce la duración de la ventilación mecánica en varias poblaciones de pacientes con menos ajustes manuales (Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-25992, ​Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.0183Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.00000000000005894).

Nuestro modo de ventilación inteligente INTELLiVENT-ASV le permitirá olvidarse prácticamente de girar los pulsadores y limitarse a supervisar los datos, reduce el número de interacciones manuales con el respirador (Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-75, Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668. 6, Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.000317), y garantiza una ventilación con protección pulmonar individualizada a sus pacientes (Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668. 6, Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.000317, Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.0018), desde la intubación hasta la extubación.

IntelliSync+ analiza de manera continua las señales de las formas de onda al menos cien veces por segundo. Esto permite que IntelliSync+ detecte el esfuerzo del paciente de manera inmediata e inicie la inspiración y la espiración en tiempo real, lo que sustituye los ajustes de disparo de inspiración y espiración convencionales.

Las soluciones convencionales para la gestión de la presión del manguito requieren que monitorice y ajuste la presión del manguito a mano.

IntelliCuff garantiza el control de la vía aérea del paciente (Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.033879) mediante la medición continua y el mantenimiento automático de la presión del manguito establecida para pacientes adultos, pediátricos y neonatos.

Paciente en silla de ruedas con respirador

Adiós al respirador. Herramientas para implementar protocolos de retirada

Queremos que nuestros respiradores estén el menor tiempo posible conectados a sus pacientes. Por eso le proporcionamos herramientas que le ayudarán a implementar su protocolo de retirada.

Estas incluyen ayudas visuales y modos de ventilación diseñados para estimular la respiración espontánea.

Profesionales mirando la formación en línea de Hamilton Medical

¡Cójale el truco! Rutas de aprendizaje y contenido educativo

Nuestra Academy en línea le ofrece rutas de aprendizaje fáciles de seguir para familiarizarse con las tecnologías y los productos de Hamilton Medical lo antes posible.

HAMILTON-S1

Todo o nada. El modelo «todo incluido».

El HAMILTON-S1 viene equipado con todas las funciones opcionales, así como con INTELLiVENT-ASV.

Para el futuro

Ilustración de una brújula que apunta hacia el futuro

Evolución constante. Ampliamos las capacidades de su respirador

Trabajamos continuamente para seguir desarrollando nuestros productos. Añadimos nuevas funciones y mejoramos las características actuales para garantizar que siempre tiene acceso a la última tecnología en ventilación a lo largo de toda la vida útil de sus respiradores.

Familia de respiradores Hamilton Familia de respiradores Hamilton

Conozca una y las conocerá todas. Interfaz de usuario universal

No importa si se utilizan en la UCI, la sala de RM o durante los traslados, todos los respiradores de Hamilton Medical funcionan de la misma forma.

Nuestro Ventilation Cockpit (cuadro de control de la ventilación) integra datos completos en visualizaciones intuitivas.

Para la solución completa

Accesorios totalmente integrados

Desarrollamos nuestros accesorios para que pueda brindar la máxima seguridad posible a los pacientes teniendo en mente en todo momento la facilidad de uso. En la medida de lo posible, los integramos en nuestros respiradores para simplificar el funcionamiento de todo el sistema del respirador.

Nuestro material fungible

Todos los productos originales de Hamilton Medical están diseñados para ofrecer un rendimiento óptimo con los respiradores de Hamilton Medical. Para garantizar la mayor satisfacción del usuario y la seguridad del paciente, nos esforzamos por cumplir las normas de seguridad y calidad más exigentes.

Referencias

  1. 1. Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care. 2021;61:191-198. doi:10.1016/j.jcrc.2020.10.025
  2. 2. Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-2599
  3. 3. Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.018
  4. 4. Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.0000000000000589
  5. 5. Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7
  6. 6. Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668.
  7. 7. Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.00031

 

  1. 8. Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.001
  2. 9. Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.03387
  3. 100. Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677.
  4. 101. Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815
  5. 102. Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD. The history and physics of heliox. Respir Care. 2006;51(6):608-612.
  6. 103. Berkenbosch JW, Grueber RE, Graff GR, Tobias JD. Patterns of helium-oxygen (heliox) usage in the critical care environment. J Intensive Care Med. 2004;19(6):335-344. doi:10.1177/0885066604269670
  7. 104. Baedorf Kassis E, Loring SH, Talmor D. Should we titrate peep based on end-expiratory transpulmonary pressure?-yes. Ann Transl Med. 2018;6(19):390. doi:10.21037/atm.2018.06.35

Notas al pie

  • a. No disponible en todos los mercados
  • b. Disponible solo para HAMILTON-C6/G5/S1
  • c. El modo Auto de IntelliCuff no está disponible en todos los mercados.

 

  • e. El HAMILTON-H900 no está aprobado para su uso durante traslados.
  • f. Also known as high flow oxygen therapy. This terminology can be used interchangeably with high flow nasal cannula therapy.

Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis.

Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care. 2021;61:191-198. doi:10.1016/j.jcrc.2020.10.025



PURPOSE

Mechanical ventilation (MV) weaning is a crucial step. Automated weaning modes reduce MV duration but the question of the best automated mode remains unanswered. Our objective was to compare the major automated modes for MV weaning in critically ill and post-operative adult patients.

MATERIAL AND METHODS

We conducted a network Bayesian meta-analysis to compare different automated modes. We searched MEDLINE, EMBASE and Cochrane central registry for randomized control trials comparing automated weaning modes either to another automated mode or to standard-of-care. The primary outcome was the duration of MV weaning extracted from the original trials.

RESULTS

663 articles were screened and 26 trials (2097patients) were included in the final analysis. All automated modes included in the study (ASV°, Intellivent ASV, Smartcare, Automode°, PAV° and MRV°) outperformed standard-of-care but no automated mode reduced the duration of mechanical ventilation weaning as compared to others in the network meta-analysis.

CONCLUSION

Compared to standard weaning practice, all automated modes significantly reduced the duration of MV weaning in critically ill and post-operative adult patients. When cross-compared using a network meta-analysis, no specific mode was different in reducing the duration of MV weaning. The study was registered in PROSPERO (CRD42015024742).

A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU.

Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-2599



BACKGROUND

Adaptive support ventilation (ASV) is a closed loop mode of mechanical ventilation (MV) that provides a target minute ventilation by automatically adapting inspiratory pressure and respiratory rate with the minimum work of breathing on the part of the patient. The aim of this study was to determine the effect of ASV on total MV duration when compared with pressure assist/control ventilation.

METHODS

Adult medical patients intubated and mechanically ventilated for > 24 h in a medical ICU were randomized to either ASV or pressure assist/control ventilation. Sedation and medical treatment were standardized for each group. Primary outcome was the total MV duration. Secondary outcomes were the weaning duration, number of manual settings of the ventilator, and weaning success rates.

RESULTS

Two hundred twenty-nine patients were included. Median MV duration until weaning, weaning duration, and total MV duration were significantly shorter in the ASV group (67 [43-94] h vs 92 [61-165] h, P = .003; 2 [2-2] h vs 2 [2-80] h, P = .001; and 4 [2-6] days vs 4 [3-9] days, P = .016, respectively). Patients in the ASV group required fewer total number of manual settings on the ventilator to reach the desired pH and Paco2 levels (2 [1-2] vs 3 [2-5], P < .001). The number of patients extubated successfully on the first attempt was significantly higher in the ASV group (P = .001). Weaning success and mortality at day 28 were comparable between the two groups.

CONCLUSIONS

In medical patients in the ICU, ASV may shorten the duration of weaning and total MV duration with a fewer number of manual ventilator settings.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01472302; URL: www.clinicaltrials.gov.

A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation.

Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.018



PURPOSE

This study aims to compare the effectiveness of weaning with adaptive support ventilation (ASV) incorporating progressively reduced or constant target minute ventilation in the protocol in postoperative care after cardiac surgery.

MATERIAL AND METHODS

A randomized controlled unblinded study of 52 patients after elective coronary artery bypass surgery was carried out to determine whether a protocol incorporating a decremental target minute ventilation (DTMV) results in more rapid weaning of patients ventilated in ASV mode compared to a protocol incorporating a constant target minute ventilation.

RESULTS

Median duration of mechanical ventilation (145 vs 309 minutes; P = .001) and intubation (225 vs 423 minutes; P = .005) were significantly shorter in the DTMV group. There was no difference in adverse effects (42% vs 46%) or mortality (0% vs 0%) between the 2 groups.

CONCLUSIONS

Use of a DTMV protocol for postoperative ventilation of cardiac surgical patients in ASV mode results in a shorter duration of ventilation and intubation without evidence of increased risk of adverse effects.

A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery.

Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.0000000000000589



BACKGROUND

Adaptive support ventilation can speed weaning after coronary artery surgery compared with protocolized weaning using other modes. There are no data to support this mode of weaning after cardiac valvular surgery. Furthermore, control group weaning times have been long, suggesting that the results may reflect control group protocols that delay weaning rather than a real advantage of adaptive support ventilation.

METHODS

Randomized (computer-generated sequence and sealed opaque envelopes), parallel-arm, unblinded trial of adaptive support ventilation versus physician-directed weaning after adult fast-track cardiac valvular surgery. The primary outcome was duration of mechanical ventilation. Patients aged 18 to 80 yr without significant renal, liver, or lung disease or severe impairment of left ventricular function undergoing uncomplicated elective valve surgery were eligible. Care was standardized, except postoperative ventilation. In the adaptive support ventilation group, target minute ventilation and inspired oxygen concentration were adjusted according to blood gases. A spontaneous breathing trial was carried out when the total inspiratory pressure of 15 cm H2O or less with positive end-expiratory pressure of 5 cm H2O. In the control group, the duty physician made all ventilatory decisions.

RESULTS

Median duration of ventilation was statistically significantly shorter (P = 0.013) in the adaptive support ventilation group (205 [141 to 295] min, n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual ventilator changes and alarms were less common in the adaptive support ventilation group, and arterial blood gas estimations were more common.

CONCLUSION

Adaptive support ventilation reduces ventilation time by more than 2 h in patients who have undergone fast-track cardiac valvular surgery while reducing the number of manual ventilator changes and alarms.

Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients.

Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7

Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial.

Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668.



BACKGROUND

Closed-loop modes automatically adjust ventilation settings, delivering individualized ventilation over short periods of time. The objective of this randomized controlled trial was to compare safety, efficacy and workload for the health care team between IntelliVent®-ASV and conventional modes over a 48-hour period.

METHODS

ICU patients admitted with an expected duration of mechanical ventilation of more than 48 hours were randomized to IntelliVent®-ASV or conventional ventilation modes. All ventilation parameters were recorded breath-by-breath. The number of manual adjustments assesses workload for the healthcare team. Safety and efficacy were assessed by calculating the time spent within previously defined ranges of non-optimal and optimal ventilation, respectively.

RESULTS

Eighty patients were analyzed. The median values of ventilation parameters over 48 hours were similar in both groups except for PEEP (7[4] cmH2O versus 6[3] cmH2O with IntelliVent®-ASV and conventional ventilation, respectively, P=0.028) and PETCO2 (36±7 mmHg with IntelliVent®-ASV versus 40±8 mmHg with conventional ventilation, P=0.041). Safety was similar between IntelliVent®-ASV and conventional ventilation for all parameters except for PMAX, which was more often non-optimal with IntelliVent®-ASV (P=0.001). Efficacy was comparable between the 2 ventilation strategies, except for SpO2 and VT, which were more often optimal with IntelliVent®-ASV (P=0.005, P=0.016, respectively). IntelliVent®-ASV required less manual adjustments than conventional ventilation (P<0.001) for a higher total number of adjustments (P<0.001). The coefficient of variation over 48 hours was larger with IntelliVent®-ASV in regard of maximum pressure, inspiratory pressure (PINSP), and PEEP as compared to conventional ventilation.

CONCLUSIONS

IntelliVent®-ASV required less manual intervention and delivered more variable PEEP and PINSP, while delivering ventilation safe and effective ventilation in terms of VT, RR, SpO2 and PETCO2.

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting.

Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.00031



BACKGROUND

The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode.

MATERIALS AND METHODS

Forty adult patients undergoing elective OPCAB were enrolled into a prospective single-center study. Patients were randomized into two groups: automated weaning (n = 20) using INTELLiVENT-ASV mode with quick-wean option; and protocolized weaning (n = 20), using conventional synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) mode. We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff. We also performed the retrospective analysis of 102 patients (standard weaning) who were weaned from ventilator with SIMV + PS mode based on physician's experience without prearranged algorithm.

RESULTS AND DISCUSSION

Realization of the automated weaning protocol required change in respiratory settings in 2 patients vs. 7 (5-9) adjustments per patient in the protocolized weaning group. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO2 during spontaneous breathing trials was significantly lower in the automated weaning group: 30 (30-35) vs. 40 (40-45) % in the protocolized weaning group (p < 0.01). The average time until tracheal extubation did not differ in the automated weaning and the protocolized weaning groups: 193 (115-309) and 197 (158-253) min, respectively, but increased to 290 (210-411) min in the standard weaning group.

CONCLUSION

The automated weaning system after off-pump coronary surgery might provide postoperative ventilation in a more protective way, reduces the workload on medical staff, and does not prolong the duration of weaning from ventilator. The use of automated or protocolized weaning can reduce the duration of postoperative mechanical ventilation in comparison with non-protocolized weaning based on the physician's decision.

Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients.

Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.001



BACKGROUND

Driving pressure (ΔP) and mechanical power (MP) are predictors of the risk of ventilation- induced lung injuries (VILI) in mechanically ventilated patients. INTELLiVENT-ASV® is a closed-loop ventilation mode that automatically adjusts respiratory rate and tidal volume, according to the patient's respiratory mechanics.

OBJECTIVES

This prospective observational study investigated ΔP and MP (and also transpulmonary ΔP (ΔPL) and MP (MPL) for a subgroup of patients) delivered by INTELLiVENT-ASV.

METHODS

Adult patients admitted to the ICU were included if they were sedated and met the criteria for a single lung condition (normal lungs, COPD, or ARDS). INTELLiVENT-ASV was used with default target settings. If PEEP was above 16 cmH2O, the recruitment strategy used transpulmonary pressure as a reference, and ΔPL and MPL were computed. Measurements were made once for each patient.

RESULTS

Of the 255 patients included, 98 patients were classified as normal-lungs, 28 as COPD, and 129 as ARDS patients. The median ΔP was 8 (7 - 10), 10 (8 - 12), and 9 (8 - 11) cmH2O for normal-lungs, COPD, and ARDS patients, respectively. The median MP was 9.1 (4.9 - 13.5), 11.8 (8.6 - 16.5), and 8.8 (5.6 - 13.8) J/min for normal-lungs, COPD, and ARDS patients, respectively. For the 19 patients managed with transpulmonary pressure ΔPL was 6 (4 - 7) cmH2O and MPL was 3.6 (3.1 - 4.4) J/min.

CONCLUSIONS

In this short term observation study, INTELLiVENT-ASV selected ΔP and MP considered in safe ranges for lung protection. In a subgroup of ARDS patients, the combination of a recruitment strategy and INTELLiVENT-ASV resulted in an apparently safe ΔPL and MPL.

Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation.

Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.03387



BACKGROUND

Maintaining endotracheal tube cuff pressure within a narrow range is an important factor in patient care. The goal of this study was to evaluate the IntelliCuff against the manual technique for maintaining cuff pressure during simulated mechanical ventilation with and without movement.

METHODS

The IntelliCuff was compared to the manual technique of a manometer and syringe. Two independent studies were performed during mechanical ventilation: part 1, a 2-h trial incorporating continuous mannikin head movement; and part 2, an 8-h trial using a stationary trachea model. We set cuff pressure to 25 cm H2O, PEEP to 10 cm H2O, and peak inspiratory pressures to 20, 30, and 40 cm H2O. Clinical importance was defined as both statistically significant (P<.05) and clinically significant (pressure change [Δ]>10%).

RESULTS

In part 1, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P<.001, Δ=-39.6%) but not for the IntelliCuff (P=.02, Δ=3.5%). In part 2, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P=.004, Δ=-14.39%) but not for the IntelliCuff (P=.20, Δ=5.65%).

CONCLUSIONS

There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures.

New frontiers in aerosol delivery during mechanical ventilation.

Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677.

The scientific basis for inhalation therapy in mechanically-ventilated patients is now firmly established. A variety of new devices that deliver drugs to the lung with high efficiency could be employed for drug delivery during mechanical ventilation. Encapsulation of drugs within liposomes could increase the amount of drug delivered, prolong the effect of a dose, and minimize adverse effects. With improved inhalation devices and surfactant formulations, inhaled surfactant could be employed for several indications in mechanically-ventilated patients. Research is unraveling the causes of some disorders that have been poorly understood, and our improved understanding of the causal mechanisms of various respiratory disorders will provide new applications for inhaled therapies.

Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation.

Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815

Recent technological advances and improved nebulizer designs have overcome many limitations of jet nebulizers. Newer devices employ a vibrating mesh or aperture plate (VM/AP) for the generation of therapeutic aerosols with consistent, increased efficiency, predominant aerosol fine particle fractions, low residuals, and the ability to nebulize even microliter volumes. These enhancements are achieved through several different design features and include improvements that promote patient compliance, such as compact design, portability, shorter treatment durations, and quiet operation. Current VM/AP devices in clinical use are the Omron MicroAir, the Nektar Aeroneb, and the Pari eFlow. However, some devices are only approved for use with specific medications. Development of "smart nebulizers" such as the Respironics I-neb couple VM technologies with coordinated delivery and optimized inhalation patterns to enhance inhaled drug delivery of specialized, expensive formulations. Ongoing development of advanced aerosol technologies should improve clinical outcomes and continue to expand therapeutic options as newer inhaled drugs become available.

The history and physics of heliox.

Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD. The history and physics of heliox. Respir Care. 2006;51(6):608-612.

Since the discovery of helium in 1868, it has found numerous applications in industry and medicine. Its low density makes helium potentially valuable in respiratory care applications, to reduce work of breathing, improve distribution of ventilation, reduce minute volume requirement, and improve aerosol delivery. This review includes a brief history of the use of heliox (a mixture of helium and oxygen) and addresses issues related to the physics of gas flow when heliox is used. Specifically covered are the Hagen-Poiseuille equation, laminar versus turbulent flow, the Reynolds number, orifice flow, Bernoulli's principle, Graham's law, wave speed, and thermal conductivity.

Patterns of helium-oxygen (heliox) usage in the critical care environment.

Berkenbosch JW, Grueber RE, Graff GR, Tobias JD. Patterns of helium-oxygen (heliox) usage in the critical care environment. J Intensive Care Med. 2004;19(6):335-344. doi:10.1177/0885066604269670

The objective of this study was to describe the patterns of heliox use in critical care units of an academic medical center. The design was a prospective case series involving 7 critical care units of an academic medical center. All patients receiving heliox therapy over a 4-year period were studied, with prospective recording of patient demographics and the location, mode, indication for, and duration of heliox use. Use pattern comparisons based on anatomic location (upper vs lower airway) and age group (pediatric vs adult) were performed by alpha(2) analysis and unpaired Student t test. Eighty-nine patients, aged 17.4 +/- 20.9 years, received heliox for 30.5 +/- 44.6 hours on 92 occasions. Pediatric (

Should we titrate peep based on end-expiratory transpulmonary pressure?-yes.

Baedorf Kassis E, Loring SH, Talmor D. Should we titrate peep based on end-expiratory transpulmonary pressure?-yes. Ann Transl Med. 2018;6(19):390. doi:10.21037/atm.2018.06.35

Ventilator management of patients with acute respiratory distress syndrome (ARDS) has been characterized by implementation of basic physiology principles by minimizing harmful distending pressures and preventing lung derecruitment. Such strategies have led to significant improvements in outcomes. Positive end expiratory pressure (PEEP) is an important part of a lung protective strategy but there is no standardized method to set PEEP level. With widely varying types of lung injury, body habitus and pulmonary mechanics, the use of esophageal manometry has become important for personalization and optimization of mechanical ventilation in patients with ARDS. Esophageal manometry estimates pleural pressures, and can be used to differentiate the chest wall and lung (transpulmonary) contributions to the total respiratory system mechanics. Elevated pleural pressures may result in negative transpulmonary pressures at end expiration, leading to lung collapse. Measuring the esophageal pressures and adjusting PEEP to make transpulmonary pressures positive can decrease atelectasis, derecruitment of lung, and cyclical opening and closing of airways and alveoli, thus optimizing lung mechanics and oxygenation. Although there is some spatial and positional artifact, esophageal pressures in numerous animal and human studies in healthy, obese and critically ill patients appear to be a good estimate for the "effective" pleural pressure. Multiple studies have illustrated the benefit of using esophageal pressures to titrate PEEP in patients with obesity and with ARDS. Esophageal pressure monitoring provides a window into the unique physiology of a patient and helps improve clinical decision making at the bedside.