Anestéziológia a intenzívna medicína 2/2017

Individualized adjustment of artificial lung ventilation parameters, such as prevention of lung parenchymal trauma

Introduction:From the point of view of ventilator-induced lung injury (VILI) prevention, it is necessary to choose „protective“ parameters of artificial lung ventilation (ALV). Aims:Application the smallest peak alveolar pressure (PAi), low tidal volumes (VT), minimum PEEPi, optimal ventilation frequency (f) and adequate PEEP. Methodology:The process of „optimizing“ a specific patient was carried out using the Chirana AURA-V software „Opti“ built in the ventilator. The authors were measured and compared of values before and after „optimization“. Results:Paw decreased by 25% (p <0.001). PAi decreased by 27%, (p <0.001). VT = 484 ml, and VTspec = 6.08 ± 0.5 ml/kg and then dropped to VT = 377 ml, VTspec = 4.8 ± 0.7 ml/kg (p <0.001). PEEP = 7.5 ± 1.5 cm H2O and we did not change. The MV changes needed to elimination of CO2 led to a 13% increase in MV. VT decreased approximately by 22% on average (P <0.001. Physician set f = 14.5 ± 0.7 d/min, increased after „optimization“, f = 21.5 ± 1.1 d/min (P <0.001). Conclusion:The results confirmed a decrease in PAi, as well as Paw and VT with a minimum changes of PEEPi and unchanged CO2 elimination from the organism as well as unchanged PaO2/FiO2. Individualized ALV parameter correction using software „optimization“ has led to a reduction of value of ventilation parameters with potentially traumatic effects on pulmonary parenchyma.

Keywords: artificial lung ventilation, ALV optimization, lung barotrauma