The dawn of physiological closed-loop ventilation-a review

Philip von Platen, Anake Pomprapa, Burkhard Lachmann, Steffen Leonhardt, Philip von Platen, Anake Pomprapa, Burkhard Lachmann, Steffen Leonhardt

Abstract

The level of automation in mechanical ventilation has been steadily increasing over the last few decades. There has recently been renewed interest in physiological closed-loop control of ventilation. The development of these systems has followed a similar path to that of manual clinical ventilation, starting with ensuring optimal gas exchange and shifting to the prevention of ventilator-induced lung injury. Systems currently aim to encompass both aspects, and early commercial systems are appearing. These developments remain unknown to many clinicians and, hence, limit their adoption into the clinical environment. This review shows the evolution of the physiological closed-loop control of mechanical ventilation.

Keywords: Closed-loop ventilation; Patient-in-the-loop; Physiological control.

Conflict of interest statement

The authors have cooperated and continued to work on closed-loop ventilation projects (SOLVe, AutoARDSNet, Oxyvent) funded by the Federal Ministry of Education and Research (BMBF, Germany).

Figures

Fig. 1
Fig. 1
Classical clinician-in-the-loop system. The physiological measurement and ventilator settings shown are only exemplary. In the clinical environment, further derived measurement variables are also used. Clinician refers to the physicians, respiratory therapists, or nurses
Fig. 2
Fig. 2
Physiological closed-loop control for mechanical ventilation system
Fig. 3
Fig. 3
Setpoint tracking and disturbance rejection shown for an illustrative example. A good controller ensures that the measured etCO2 closely follows the setpoint. At t1, a setpoint change (change in target) requires an increase in minute volume (bottom graph). At t2, a sudden increase in CO2 (disturbance) requires another increase in MV
Fig. 4
Fig. 4
Control topology for a fully automated physiological closed-loop ventilation. Measurement signals fed back to the controller are categorized according to the control target. The list of physiological measurements is not complete but shows only examples taken from the presented PCLC systems

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