title: Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography.
abstract: BACKGROUND
  Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.
  
  
  METHODS
  A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.
  
  
  RESULTS
  This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.
  
  
  CONCLUSIONS
  We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects.
authors: Anake
authors: A
authors: Pomprapa
authors: David
authors: D
authors: Schwaiberger
authors: Philipp
authors: P
authors: Pickerodt
authors: Onno
authors: O
authors: Tjarks
authors: Burkhard
authors: B
authors: Lachmann
authors: Steffen
authors: S
authors: Leonhardt
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D017097:Electric Impedance; D005260:Female; D006863:Hydrogen-Ion Concentration; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods*; D012123:Pulmonary Ventilation; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D013990:Tidal Volume; D014054:Tomography / Q000379:methods*
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen