Current-generation intensive care unit ventilators. The single feature that distinguishes this generation is the plethora of ventilation modes available. In addition, many of these new modes are based on closed-loop control. Does it decrease the likelihood of ventilator-induced lung injury or hemodynamic compromise? Does it more effectively ventilate or oxygenate the patient? Does it wean the patient from ventilatory support faster?
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Current-generation intensive care unit ventilators. The single feature that distinguishes this generation is the plethora of ventilation modes available. In addition, many of these new modes are based on closed-loop control. Does it decrease the likelihood of ventilator-induced lung injury or hemodynamic compromise?
Does it more effectively ventilate or oxygenate the patient? Does it wean the patient from ventilatory support faster? Does it improve patient-ventilator synchrony? If the answer to each of those questions is no, then the mode is essentially useless. Fortunately, most of these newer modes do seem to have a yes answer to at least one of the questions.
Most of these new modes are, for the most part, based on a pressure-targeted approach. Maybe the most complex of these modes is adaptive support ventilation, which attempts to establish a ventilatory pattern based on the Otis work-of-breathing model. This pattern is established by the ventilator automatically adjusting the ventilating pressure and respiratory rate. SmartCare is another form of closed-loop control of pressure support for weaning.
When the pressure support level is reduced to a predetermined level, the ventilator automatically performs a spontaneous breathing trial SBT. If the patient passes the SBT, the ventilator notifies the user that the patient should be considered for extubation.
A recent randomized controlled trial compared SmartCare to clinician-performed weaning and found that patients were weaned faster with SmartCare. A more recent study in which the control group was weaned per the protocol, found no benefit from SmartCare.
Proportional assist ventilation and neurally adjusted ventilatory assist are available on the fourth generation of ventilators, but should be considered modes of the future. Proportional assist ventilation functions by responding to the mechanical output of the diaphragm and accessory muscles of inspiration inspiratory flow and volume , 44 whereas neurally adjusted ventilatory assist functions by responding to the neural input to the diaphragm electrical activity.
No randomized trials comparing these modes to conventional mechanical ventilation have been published to date, but I expect that the ability of these modes to improve patient outcomes will be shown in the future. Almost all of the ventilators in this generation include NIV modes,.
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Learn how and when to remove this template message The history of mechanical ventilation begins with various versions of what was eventually called the iron lung , a form of noninvasive negative-pressure ventilator widely used during the polio epidemics of the twentieth century after the introduction of the "Drinker respirator" in , improvements introduced by John Haven Emerson in ,  and the Both respirator in Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation , the rocking bed, and rather primitive positive pressure machines. Mechanical ventilators began to be used increasingly in anaesthesia and intensive care during the s. Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anaesthesia. Relaxant drugs paralyse the patient and improve operating conditions for the surgeon but also paralyse the respiratory muscles. The former used a Sturmey-Archer bicycle hub gear to provide a range of speeds, and the latter an automotive windscreen wiper motor to drive the bellows used to inflate the lungs. In , Roger Manley of the Westminster Hospital , London, developed a ventilator which was entirely gas-driven and became the most popular model used in Europe.
Manufacturer Specifications - ERICA ICU Ventilator, Engstrom Medical
Respiratory Rental Inventory