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    Dräger Flow Acceleration Feature v5.5.21

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    Marlon Poke
    The Dräger Savina ventilator uses a feature called Flow Acceleration in modes like IPPV and SIMV. Flow Acceleration controls the rate of increase in airway pressure during inspiration through a preset slope, making it a form of pressure control ventilation despite being labeled as volume control. Adding features like Pressure Limited Ventilation or AutoFlow changes the classification of these modes to include dual targeting schemes or adaptive targeting. In summary, Flow Acceleration implements pressure control through linear targeting of the inspiratory pressure slope rather than a peak pressure setpoint.

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    Dräger Flow Acceleration Feature v5.5.21

    Uploaded by

    Marlon Poke
    1K views4 pages
    The Dräger Savina ventilator uses a feature called Flow Acceleration in modes like IPPV and SIMV. Flow Acceleration controls the rate of increase in airway pressure during inspiration through a preset slope, making it a form of pressure control ventilation despite being labeled as volume control. Adding features like Pressure Limited Ventilation or AutoFlow changes the classification of these modes to include dual targeting schemes or adaptive targeting. In summary, Flow Acceleration implements pressure control through linear targeting of the inspiratory pressure slope rather than a peak pressure setpoint.

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    The Dräger Savina ventilator uses a feature called Flow Acceleration in modes like IPPV and SIMV. Flow Acceleration controls the rate of increase in airway pressure during inspiration through a preset slope, making it a form of pressure control ventilation despite being labeled as volume control. Adding features like Pressure Limited Ventilation or AutoFlow changes the classification of these modes to include dual targeting schemes or adaptive targeting. In summary, Flow Acceleration implements pressure control through linear targeting of the inspiratory pressure slope rather than a peak pressure setpoint.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views4 pages

    Dräger Flow Acceleration Feature v5.5.21

    Uploaded by

    Marlon Poke
    The Dräger Savina ventilator uses a feature called Flow Acceleration in modes like IPPV and SIMV. Flow Acceleration controls the rate of increase in airway pressure during inspiration through a preset slope, making it a form of pressure control ventilation despite being labeled as volume control. Adding features like Pressure Limited Ventilation or AutoFlow changes the classification of these modes to include dual targeting schemes or adaptive targeting. In summary, Flow Acceleration implements pressure control through linear targeting of the inspiratory pressure slope rather than a peak pressure setpoint.

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    © All Rights Reserved
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    of 4

    Dräger Flow Acceleration Feature

    Prof. Robert L. Chatburn, MHHS, RRT-NPS, FAARC ​5/5/2021

    The Savina ventilator (Dräger) has a mode called Volume-Controlled Ventilation IPPV.
    According to the operator’s manual, the settings for this mode include tidal volume, frequency,
    inspiration time, PEEP, and flow acceleration. The manual describes flow acceleration this way:
    “With the parameter »FlowAcc« the pressure and flow increase can be influenced. A greater
    Flow acceleration produces a steeper pressure and flow increase. Flow acceleration (and the
    inspiration time) can be used to adapt the pressure and flow curve to suit the individual patient’s
    needs.” This is illustrated in Figure 1.

    Figure 1. Effects of flow acceleration setting on pressure and flow waveforms.

    Upon questioning the manufacturer representative (Broos, Erwin [email protected];


    Senior Product Manager, Respiratory Care, Office: +49-451-882-3392, Mobile: +49-170-
    8544224) I got this explanation:
    “In volume controlled ventilation Savina is using FlowAcceleration as a simple straight pressure
    slope with the constant steepness of the set FlowAcc (range is 5 to 200 mbar/sec). The slope
    starts at PEEP level and ends if the desired VT is applied. In the simulated data (Figure 2) we
    have compared ideal VC, ideal PC and FlowAcc for the same volume target.
    The underlying control principle for the driving force in Savina VC-modes is pressure control.
    The required pressure is generated by a turbine in combination with a valve (inspiratory valve).
    The pressure is directly controlled by this valve. In the proper sense Savina is a pressure
    controlled ventilator. However, in volume controlled modes the inspiratory flow is directly
    measured and integrated to (display) volume. If the desired volume is reached the driving
    pressure is reduced immediately. The desired VT is reached very accurately with every cycle in
    contrast to PRVC (respectively Draegers Autoflow) where VT fluctuates with every breath.”

    Figure 2. Simulated data (C=26ml/mbar, R=22mbar/l/s, vt=350ml, flowAcc=30mbar/s)


    Dräger did not supply the equation for controlling pressure but I assume it is something like that
    1
    derived by in the paper by Marini and Crooke (see Figure 3).

    Figure 3. Clip from paper by Marini and Crooke describing constant volume ventilation by means of pressure control using a
    linear model for airway pressure as a function of time. The slope of the pressure rise, a, is analogous to the Flow Acceleration
    setting.

    Taxonomy
    We will now deduce the taxonomy of modes on the Savina ventilator with the Flow Acceleration
    feature activated.
    Control Variable
    2
    The definition of volume control is that both tidal volume and flow are preset. In contrast, the
    definition of pressure control is that either the inspiratory pressure target is preset of inspiratory
    2
    pressure is proportional to the patient’s inspiratory effort. From the description above (and the
    communication from the manufacturer), the Flow Acceleration feature in the mode called IPPV
    is clearly a form of pressure control. This is despite the explanation in the operator’s manual that
    this is a “volume control” mode. The operator sets a target tidal volume and an inspiratory time,
    but not the inspiratory flow time, hence inspiratory flow is determined by pressure control
    algorithm and will change as the load changes (ie, respiratory system resistance and compliance).
    Furthermore, the manual states that “inspiration time (ie, inspiratory flow time) is not adjustable,
    but it is the result of the compliance and resistance of the patient’s lungs together with the set
    values tidal volume and flow acceleration.”
    Breath Sequence
    Intermittent Positive Pressure Ventilation (IPPV) is evidently a form of continuous mandatory
    2
    ventilation, as opposed to intermittent mandatory ventilation. The manual says “The Start of the
    mandatory inspiration can be synchronized with the patient’s inhalation effort with the help of
    the variable flow trigger. The flow trigger can only be completely turned off in IPPV (IPPVAssist
    –> IPPV).” The manual further states that “The steepness of the pressure increase from PEEP
    level to the inspiration level can further be adapted with the ventilation parameter FlowAcc in
    SIMV and IPPV to suit the patient’s needs.” Hence, we see that the ventilator produces both
    CMV and IMV breath sequences.
    Targeting Schemes
    There are seven basic targeting schemes used by all ventilators. From the descriptions shown in
    Table 1, we can see that only set-point targeting applies to Flow Acceleration. However, it is a
    unique application in the preset target is not the peak value of the pressure waveform (ie,
    inspiratory pressure) but rather the slope of the pressure waveform.
    Table 1. Targeting schemes for modes of ventilation.
    Mode Classifications
    Because there are several features that can be activated in combination, many more modes are
    available than what are listed in the table of contents of the operator’s manual.
    Modes with Set-Point Targeting
    From the above analysis, the modes that use Flow Acceleration on the Dräger Savina ventilator
    are as follows:
    • IPPV: PC-CMVs
    • IPPVassist: PC-CMVs
    • SIMV: PC-IMV(1)s,s
    • SIMV/ASB: PC-IMV(1)s,s
    But there is an added complication: this ventilator allows the addition of a Pressure Limited
    Ventilation (PLV) feature. This allows the operator to set a maximum inspiratory pressure limit
    (Pmax) in IPPV, IPPVAssist and SIMV and SIMV/ASB modes (Figure 4). In this case, the first
    part of inspiration is pressure control with the flow assist algorithm and the last part is pressure
    control with a simple static inspiratory pressure target. Thus, if PLV is activated on top of Flow
    Acceleration, we would like to account for this complication, particularly because the pressure
    waveform might look a lot like volume control with dual targeting. The way to do this is to
    specify that there are two “varieties” of the modes above. One is simple set-point targeting using
    the pressure slope and the other uses two forms of set-point targeting; (1) Flow Acceleration
    alone), and (2) target slope with target inspiratory pressure together (Flow acceleration plus
    Pressure Limited). This situation is similar to the way that there are three distinct varieties of PC-
    CSVr: NAVA, PAV, and Tube Compensation.
    Figure 4. Pressure Limited Ventilation using the Pinsp setting.

    Modes with Adaptive Targeting


    Another feature on the Savina ventilator is called AutoFlow. This is the name for pressure
    control with adaptive targeting (ie, inspiratory pressure target is automatically adjusted to
    achieve an average tidal volume, over several breaths, equal to the preset tidal volume). If
    AutoFlow is activated on top of Flow Acceleration, the mode classifications change to:
    • IPPV: PC-CMVsa
    • IPPVassist: PC-CMVsa
    • SIMV: PC-IMV(1)sa,s
    • SIMV/ASB: PC-IMV(1)sa,s
    This is shown in Figure 5.

    Figure 5. AutoFlow activated in addition to Flow Acceleration.


    References
    1. ​Marini JJ, Crooke PS. A general mathematical model for respiratory dynamics relevant
    to the clinical setting. Am Rev Respir Dis. 1993;147(1):14-24.
    2. ​Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical
    ventilation: 10 fundamental maxims. Respir Care. 2014;59(11):1747-1763.

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