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Autoflow
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AutoFlow® The Oxylog 3000 plus incorporates the benefits of pressure controlled ventilation into volume controlled ventilation

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Dear reader, Performing mechanical ventilation during emergency care is a real challenge. Especially in out-of-hospital situations there are many problems to solve in a minimum of time. In addition, environmental factors play an important role in the performance that can be achieved. In emergency situations, patients often have spontaneous respiratory efforts. However, when mechanical ventilation is needed in the field, many health care providers prefer volume controlled ventilation modes. Deep sedation is needed to let the patient accept this kind of ventilation, often complicated by...

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AUTOFLOW IN EMERGENCY CARE & TRANSPORT VENTILATION Editor Drager Medical GmbH Moislinger Allee 53-55 D-23542 Lubeck www.draeger.com Authors Prof. Frans L. Rutten, MD Application & Training Specialist Clinical Consultant Drager Medical b.v. Kanaaldijk 29 NL-5683 CR Best, The Netherlands Application & Training Specialist: Thomas Peyn Drager Medical GmbH Moislinger Allee 53-55 D - 23542 Lubeck Germany Important notes Medical knowledge is subject to constant change due to research and clinical experience. The authors of this publication have taken utmost care to ensure that all...

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3. What happens when AutoFlow is activated? 8 4. How are spontaneous efforts mixed with mandatory volume controlled strokes? 10 5. How does AutoFlow compare to PC-BIPAP/PC-SIMV+12?12 6. How does AutoFlow work with VC-CMV and VC? 13 7. How does AutoFlow work with VC-SIMV? 14 8. What advantages are observed when using AutoFlow? 15 11. What monitoring parameters are important to observe when using AutoFlow? 20 12. What safeguards are there against hypo/hyperventilation? 22 13. What is the value of AutoFlow in patients with head injury or stroke? 23 14. What is...

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AUTOFLOW IN EMERGENCY CARE & TRANSPORT VENTILATION 1. What is AutoFlow? AutoFlow is an adjunct to volume controlled ventilation mode, it automatically regulates inspiratory flow and inspiratory pressure. When AutoFlow is activated the inspiratory flow pattern changes from the constant flow typical of volume controlled ventilation to a decelerating flow pattern usually associated with pressure controlled ventilation. AutoFlow – s available in all volume controlled modes such as VC-CMV, VC-AC, I VC-SIMV, VC-SIMV/PS. – elivers the set tidal volume at the lowest possible inspiratory pressure. D...

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2. How is AutoFlow set up? AutoFlow is an adjunct to volume controlled ventilation mode. It is found in the Oxylog 3000 plus “settings” menu. Once the function has been selected it is switched on by pressing the rotary knob. There is no need to change other settings or alarm limits once AutoFlow is activated as long as they meet clinical needs. The Pmax setting has an additional function during AutoFlow: it limits the inspiratory pressure control to a level of 5 mbar below the Pmax setting. AutoFlow is only available in volume controlled modes

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AUTOFLOW IN EMERGENCY CARE & TRANSPORT VENTILATION 3. What happens when AutoFlow is activated? Once AutoFlow is activated the next mandatory ventilation stroke is delivered with the minimal flow required to deliver the set volume within the set inspiratory time. The resulting end inspiratory pressure is used as the inspiratory pressure for the next breath. Subsequently a decelerating inspiratory flow profile is used. Once expiration begins delivered (inspiratory) volume is compared to the set tidal volume. The inspiratory pressure of the next mandatory stroke is adjusted, up or down,...

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Pressure Volume Controlled Switch-on AutoFlow® Compliance improvement

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AUTOFLOW IN EMERGENCY CARE & TRANSPORT VENTILATION 4. ow are spontaneous efforts mixed with H mandatory volume controlled strokes? Traditionally in volume controlled modes the ventilator closes the expiratory and opens the inspiratory valve for a defined period of time. After the gas has been delivered a pause (plateau) may occur and both valves are closed before the expiratory valve opens to enable expiration. Generally the ventilator does not respond to spontaneous efforts during such a mandatory stroke. High or low airway pressure alarms may be seen and are obvious indicators that the...

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Several technical requirements have to be met to improve breathing comfort and reduce the invasiveness of mechanical ventilation: apart from the need to have a fast gas delivery system to meet additional flow requirements it is also necessary for the expiratory valve to respond immediately in case of pressure rises. This “Room to Breathe” concept was realized in the pressure controlled PC-BIPAP/PC-SIMV+ mode for the very first time. AutoFlow incorporates the same “Room to Breathe” principles as PC-BIPAP/PC-SIMV+, enabling spontaneous breathing throughout the respiratory cycle which...

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AUTOFLOW IN EMERGENCY CARE & TRANSPORT VENTILATION 5. How does AutoFlow compare to PC-BIPAP*/PC-SIMV+ ? Volume controlled ventilation with AutoFlow and PC-BIPAP/PC-SIMV+ both facilitate the “Room to Breathe” concept and allow the patient to breathe spontaneously at any time in the respiratory cycle. PC-BIPAP/PC-SIMV+ is a pressure controlled mode and the tidal volume (VT) provided results from the pressure difference between inspiratory (Pinsp) and expiratory (PEEP) pressure. Changes in lung compliance during PC-BIPAP/PC-SIMV+ cause changes in tidal volume. AutoFlow follows a different...

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6. ow does AutoFlow work with VC-CMV and H VC-AC? VC-CMV is a volume controlled mode and does not respond to patient effort. With VC-AC the patient can trigger additional mandatory strokes. AutoFlow does not change the cycling characteristic of any mode and ventilation can be conducted as usual. When the patient starts making spontaneous breathing efforts AutoFlow increases or decreases the gas flow according to these efforts. Such an improvement in synchrony can reduce the frequency of airway pressure alarms and increase breathing comfort dramatically.

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