Clinically Relevant Solutions
Optimizing Patient Care
Gentle Lung® Suite
Nihon Kohden’s ventilator systems offer convenient tools for clinicians to practice lung protective ventilation:
Patients receiving mechanical ventilation may suffer from ventilator-induced lung injury. This may be caused by inappropriate tidal volume¹, inappropriate driving pressure², and inappropriate PEEP³.
Guided Solutions
Lung protective ventilation is a well-established practice not only in ARDS patients but also in postoperative patients⁴. Gentle Lung Suite provides guided tools for individualized lung protective strategies
Recruitability Assessment (RA)
Provides clinicians insights into patients’ lungs to help determine if a recruitment maneuver could be beneficial.
Preparation for RA:
- Clinicians can set and visualize settings with a PEEP time-based graph of incremental and decremental PEEP-step sequences
During RA:
- The ventilator performs incremental increase and decrease of PEEP as set.
- A real-time graph of PEEP and estimated compliance are displayed during RA.
Post RA analysis:
- The ventilator compares tidal volume and lung compliance between incremental and decremental portions of RA at the same PEEP
- The application provides results of gain in compliance and recruitable volume for the clinician to make an informed decision if the patient will benefit from recruitment maneuver.
Recruitment Maneuver (RM)
Customized, stepwise lung recruitment maneuvers enable clinicians to focus on the patient.
Preparation for RM:
- Clinicians evaluate RA results, to determine if RM may be beneficial.
- A visual guide of a PEEP time-based graph is available as clinicians set the parameters for the RM.
During RM:
- The ventilator performs stepwise RM as set while clinicians can focus on monitoring their patients.
Post RM:
- After patient’s lungs are recruited, clinicians may choose to continue to PEEP-Titration or resume normal ventilation.
PEEP-Titration (PEEP-T)
Continuation of recruitment maneuver or independently initiated to help determine PEEP at best compliance.
Preparation for PEEP-T:
- A visual guide of the PEEP time-based graph is available as clinicians set the parameters for PEEP-T
- Clinicians set the decremental PEEP starting from the ending PEEP of RM or the patient’s current PEEP level.
During PEEP-T:
- The ventilator performs stepwise PEEP as set.
- Real-time graphs of PEEP and estimated compliance are displayed during PEEP-T
Post PEEP-T analysis:
- The application provides the results of PEEP at the highest compliance measured during PEEP-T.
- A cursor will appear on time graphs for clinicians to view values of measured results throughout PEEP-T
Transpulmonary Pressures (Ptp)
Monitors the transpulmonary pressure to help individualize a lung protective treatment strategy
Main Functions of Ptp App:
- Measures Driving Pressure and Peak value, Mean value, Plateau values, and End-Expiratory value of Ptp continuously using an esophageal balloon catheter.
- A real-time Ptp waveform is displayed for simple monitoring.
Studies suggested that end-expiratory Ptp is best between 0-10 cmH₂O to improve oxygen and respiratory compliance in patients with ARDS⁵. Ptp App provides realtime measurement of Ptp to help clinicians closely monitor Ptp while cautiously adjusting PEEP to achieve this goal.
¹ The Acute Respiratory Distress Syndrome Network.Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med. 2000 Feb;342(18):1301–8.
² Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med. 2015;372(8):747–55.
³ Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: Systematic review and meta-analysis. JAMA. 2010;303(9):865–73.
⁴ Fumagalli J, Santiago RRS, Teggia Droghi M, Zhang C, Fintelmann FJ, Troschel FM, et al. Lung Recruitment in Obese Patients with Acute Respiratory Distress Syndrome. Anesthesiology. 2019;130(5):791–803.
⁵ Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008 Nov 13;359(20):2095–104.
Guided Solutions
Lung protective ventilation is a well-established practice not only in ARDS patients but also in postoperative patients⁴. Gentle Lung Suite provides guided tools for individualized lung protective strategies
Provides clinicians insights into patients’ lungs to help determine if a recruitment maneuver could be beneficial.
Preparation for RA:
- Clinicians can set and visualize settings with a PEEP time-based graph of incremental and decremental PEEP-step sequences
During RA:
- The ventilator performs incremental increase and decrease of PEEP as set.
- A real-time graph of PEEP and estimated compliance are displayed during RA.
Post RA analysis:
- The ventilator compares tidal volume and lung compliance between incremental and decremental portions of RA at the same PEEP
- The application provides results of gain in compliance and recruitable volume for the clinician to make an informed decision if the patient will benefit from recruitment maneuver.
Customized, stepwise lung recruitment maneuvers enable clinicians to focus on the patient.
Preparation for RM:
- Clinicians evaluate RA results, to determine if RM may be beneficial.
- A visual guide of a PEEP time-based graph is available as clinicians set the parameters for the RM.
During RM:
- The ventilator performs stepwise RM as set while clinicians can focus on monitoring their patients.
Post RM:
- After patient’s lungs are recruited, clinicians may choose to continue to PEEP-Titration or resume normal ventilation.
Continuation of recruitment maneuver or independently initiated to help determine PEEP at best compliance.
Preparation for PEEP-T:
- A visual guide of the PEEP time-based graph is available as clinicians set the parameters for PEEP-T
- Clinicians set the decremental PEEP starting from the ending PEEP of RM or the patient’s current PEEP level.
During PEEP-T:
- The ventilator performs stepwise PEEP as set.
- Real-time graphs of PEEP and estimated compliance are displayed during PEEP-T
Post PEEP-T analysis:
- The application provides the results of PEEP at the highest compliance measured during PEEP-T.
- A cursor will appear on time graphs for clinicians to view values of measured results throughout PEEP-T
Monitors the transpulmonary pressure to help individualize a lung protective treatment strategy
Main Functions of Ptp App:
- Measures Driving Pressure and Peak value, Mean value, Plateau values, and End-Expiratory value of Ptp continuously using an esophageal balloon catheter.
- A real-time Ptp waveform is displayed for simple monitoring.
Studies suggested that end-expiratory Ptp is best between 0-10 cmH₂O to improve oxygen and respiratory compliance in patients with ARDS⁵. Ptp App provides realtime measurement of Ptp to help clinicians closely monitor Ptp while cautiously adjusting PEEP to achieve this goal.
¹ The Acute Respiratory Distress Syndrome Network.Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med. 2000 Feb;342(18):1301–8.
² Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med. 2015;372(8):747–55.
³ Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: Systematic review and meta-analysis. JAMA. 2010;303(9):865–73.
⁴ Fumagalli J, Santiago RRS, Teggia Droghi M, Zhang C, Fintelmann FJ, Troschel FM, et al. Lung Recruitment in Obese Patients with Acute Respiratory Distress Syndrome. Anesthesiology. 2019;130(5):791–803.
⁵ Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008 Nov 13;359(20):2095–104.
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