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Variable Ventilation from Bench to Bedside

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Annual Update in Intensive Care and Emergency Medicine 2016

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Biological systems constantly adjust their inner condition according to the external environment in order to achieve a steady state that allows their adaptation to the environment. Healthy biological systems are able to quickly adapt to changing environmental conditions and exhibit intrinsic fluctuations in function within each subsystem, for example the cardiovascular [1] and respiratory [2] systems, during steady-state conditions. In diseased biological systems, however, such intrinsic functional fluctuation (variability) is usually reduced. In fact, reduced variability of the heart rate in patients with coronary heart disease [3], of blood pressure during pre-eclampsia [4], of heart rate and blood pressure during pathological sleep [5], and of respiratory rate and tidal volume in patients with chronic obstructive pulmonary disease (COPD) [6] and prolonged weaning [7] have been documented.

Different from most biological systems, the variability of the respiratory system can be easily influenced in an attempt to improve its function. In controlled, as well as in assisted mechanical ventilation, the variability of tidal volume and/or respiratory rate may be modulated externally by the mechanical ventilator to reproduce certain characteristics of spontaneous breathing in healthy subjects. Because mechanical ventilation represents a common intervention in intensive care and emergency medicine, interest in modes that can enhance the variability of the respiratory pattern has increased in recent years.

In this article, we will review the rationale and mechanisms of variable ventilation, and provide a comprehensive review of the literature for both controlled and assisted variable mechanical ventilation. We will focus mainly on the translational aspects that may be relevant for the clinical practice of mechanical ventilation.

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Authors and Affiliations

  1. Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    R. Huhle & M. G. de Abreu

  2. Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, 16131, Genoa, Italy

    P. Pelosi

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  1. R. Huhle
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  2. P. Pelosi
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  3. M. G. de Abreu
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Correspondence to P. Pelosi .

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Editors and Affiliations

  1. Université libre de Bruxelles Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent

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Huhle, R., Pelosi, P., de Abreu, M.G. (2016). Variable Ventilation from Bench to Bedside. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2016. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-27349-5_23

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  • DOI: https://doi.org/10.1007/978-3-319-27349-5_23

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27348-8

  • Online ISBN: 978-3-319-27349-5

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