Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate
Abstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units. Distal airway mucus clearance has been shown to reduce VAP incidence. Studies suggest that mucus clearance is enhanced when the rate of expiratory flow is greater than inspirato...
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doaj-1410fde39cae4860a609b9d02e18d3c52020-11-25T03:36:34ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2019-05-017111110.1186/s40635-019-0250-5Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rateMelissa Mahajan0David DiStefano1Joshua Satalin2Penny Andrews3Hassan al-Khalisy4Sarah Baker5Louis A. Gatto6Gary F. Nieman7Nader M. Habashi8Department of Surgery, SUNY Upstate Medical UniversityDepartment of Surgery, SUNY Upstate Medical UniversityDepartment of Surgery, SUNY Upstate Medical UniversityDepartment of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of MedicineDepartment of Surgery, SUNY Upstate Medical UniversityDepartment of Surgery, SUNY Upstate Medical UniversityDepartment of Biological Sciences, SUNY CortlandDepartment of Surgery, SUNY Upstate Medical UniversityDepartment of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of MedicineAbstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units. Distal airway mucus clearance has been shown to reduce VAP incidence. Studies suggest that mucus clearance is enhanced when the rate of expiratory flow is greater than inspiratory flow. The time-controlled adaptive ventilation (TCAV) protocol using the airway pressure release ventilation (APRV) mode has a significantly increased expiratory relative to inspiratory flow rate, as compared with the Acute Respiratory Distress Syndrome Network (ARDSnet) protocol using the conventional ventilation mode of volume assist control (VAC). We hypothesized the TCAV protocol would be superior to the ARDSnet protocol at clearing mucus by a mechanism of net flow in the expiratory direction. Methods Preserved pig lungs fitted with an endotracheal tube (ETT) were used as a model to study the effect of multiple combinations of peak inspiratory (IPF) and peak expiratory flow rate (EPF) on simulated mucus movement within the ETT. Mechanical ventilation was randomized into 6 groups (n = 10 runs/group): group 1—TCAV protocol settings with an end-expiratory pressure (PLow) of 0 cmH2O and PHigh 25 cmH2O, group 2—modified TCAV protocol with increased PLow 5 cmH2O and PHigh 25 cmH2O, group 3—modified TCAV with PLow 10 cmH2O and PHigh 25 cmH2O, group 4—ARDSnet protocol using low tidal volume (LTV) and PEEP 0 cmH2O, group 5—ARDSnet protocol using LTV and PEEP 10 cmH2O, and group 6—ARDSnet protocol using LTV and PEEP 20 cmH2O. PEEP of ARDSnet is analogous to PLow of TCAV. Proximal (towards the ventilator) mucus movement distance was recorded after 1 min of ventilation in each group. Results The TCAV protocol groups 1, 2, and 3 generated significantly greater peak expiratory flow (EPF 51.3 L/min, 46.8 L/min, 36.8 L/min, respectively) as compared to the ARDSnet protocol groups 4, 5, and 6 (32.9 L/min, 23.5 L/min, and 23.2 L/min, respectively) (p < 0.001). The TCAV groups also demonstrated the greatest proximal mucus movement (7.95 cm/min, 5.8 cm/min, 1.9 cm/min) (p < 0.01). All ARDSnet protocol groups (4–6) had zero proximal mucus movement (0 cm/min). Conclusions The TCAV protocol groups promoted the greatest proximal movement of simulated mucus as compared to the ARDSnet protocol groups in this excised lung model. The TCAV protocol settings resulted in the highest EPF and the greatest proximal movement of mucus. Increasing PLow reduced proximal mucus movement. We speculate that proximal mucus movement is driven by EPF when EPF is greater than IPF, creating a net force in the proximal direction.http://link.springer.com/article/10.1186/s40635-019-0250-5Airway pressure release ventilation (APRV) modeExpiratory flow rateMucusTime-controlled adaptive ventilation (TCAV)Ventilator-associated pneumonia (VAP)ARDSnet ventilation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Melissa Mahajan David DiStefano Joshua Satalin Penny Andrews Hassan al-Khalisy Sarah Baker Louis A. Gatto Gary F. Nieman Nader M. Habashi |
spellingShingle |
Melissa Mahajan David DiStefano Joshua Satalin Penny Andrews Hassan al-Khalisy Sarah Baker Louis A. Gatto Gary F. Nieman Nader M. Habashi Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate Intensive Care Medicine Experimental Airway pressure release ventilation (APRV) mode Expiratory flow rate Mucus Time-controlled adaptive ventilation (TCAV) Ventilator-associated pneumonia (VAP) ARDSnet ventilation |
author_facet |
Melissa Mahajan David DiStefano Joshua Satalin Penny Andrews Hassan al-Khalisy Sarah Baker Louis A. Gatto Gary F. Nieman Nader M. Habashi |
author_sort |
Melissa Mahajan |
title |
Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate |
title_short |
Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate |
title_full |
Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate |
title_fullStr |
Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate |
title_full_unstemmed |
Time-controlled adaptive ventilation (TCAV) accelerates simulated mucus clearance via increased expiratory flow rate |
title_sort |
time-controlled adaptive ventilation (tcav) accelerates simulated mucus clearance via increased expiratory flow rate |
publisher |
SpringerOpen |
series |
Intensive Care Medicine Experimental |
issn |
2197-425X |
publishDate |
2019-05-01 |
description |
Abstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units. Distal airway mucus clearance has been shown to reduce VAP incidence. Studies suggest that mucus clearance is enhanced when the rate of expiratory flow is greater than inspiratory flow. The time-controlled adaptive ventilation (TCAV) protocol using the airway pressure release ventilation (APRV) mode has a significantly increased expiratory relative to inspiratory flow rate, as compared with the Acute Respiratory Distress Syndrome Network (ARDSnet) protocol using the conventional ventilation mode of volume assist control (VAC). We hypothesized the TCAV protocol would be superior to the ARDSnet protocol at clearing mucus by a mechanism of net flow in the expiratory direction. Methods Preserved pig lungs fitted with an endotracheal tube (ETT) were used as a model to study the effect of multiple combinations of peak inspiratory (IPF) and peak expiratory flow rate (EPF) on simulated mucus movement within the ETT. Mechanical ventilation was randomized into 6 groups (n = 10 runs/group): group 1—TCAV protocol settings with an end-expiratory pressure (PLow) of 0 cmH2O and PHigh 25 cmH2O, group 2—modified TCAV protocol with increased PLow 5 cmH2O and PHigh 25 cmH2O, group 3—modified TCAV with PLow 10 cmH2O and PHigh 25 cmH2O, group 4—ARDSnet protocol using low tidal volume (LTV) and PEEP 0 cmH2O, group 5—ARDSnet protocol using LTV and PEEP 10 cmH2O, and group 6—ARDSnet protocol using LTV and PEEP 20 cmH2O. PEEP of ARDSnet is analogous to PLow of TCAV. Proximal (towards the ventilator) mucus movement distance was recorded after 1 min of ventilation in each group. Results The TCAV protocol groups 1, 2, and 3 generated significantly greater peak expiratory flow (EPF 51.3 L/min, 46.8 L/min, 36.8 L/min, respectively) as compared to the ARDSnet protocol groups 4, 5, and 6 (32.9 L/min, 23.5 L/min, and 23.2 L/min, respectively) (p < 0.001). The TCAV groups also demonstrated the greatest proximal mucus movement (7.95 cm/min, 5.8 cm/min, 1.9 cm/min) (p < 0.01). All ARDSnet protocol groups (4–6) had zero proximal mucus movement (0 cm/min). Conclusions The TCAV protocol groups promoted the greatest proximal movement of simulated mucus as compared to the ARDSnet protocol groups in this excised lung model. The TCAV protocol settings resulted in the highest EPF and the greatest proximal movement of mucus. Increasing PLow reduced proximal mucus movement. We speculate that proximal mucus movement is driven by EPF when EPF is greater than IPF, creating a net force in the proximal direction. |
topic |
Airway pressure release ventilation (APRV) mode Expiratory flow rate Mucus Time-controlled adaptive ventilation (TCAV) Ventilator-associated pneumonia (VAP) ARDSnet ventilation |
url |
http://link.springer.com/article/10.1186/s40635-019-0250-5 |
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