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Using INTELLiVENT-ASV in patients with severe V/Q mismatch

Articolo

Autore: Clinical Experts Group, Hamilton Medical

Data: 07.11.2019

When using INTELLiVENT-ASV®, how can I increase %MinVol when PetCO2 is low and the CO2 target shift setting is already on the maximum of -20?

Using INTELLiVENT-ASV in patients with severe V/Q mismatch

Ventilation perfusion mismatch

In certain patient conditions, the arterial partial pressure of CO2 (PaCO2) obtained by an arterial blood gas analysis can be much higher than the end-tidal partial pressure of CO2 (PetCO2) derived by capnography. Typically this can be observed whenever the patient suffers a ventilation perfusion (V/Q) mismatch; for example, due to a severe ARDS, a pulmonary embolism or hypovolemic shock.

In cases where the patient’s PetCO2 is below the PetCO2 target zone over a period of time, the ventilation controller will maintain the minimum minute volume of 70% in INTELLiVENT-ASV.

How to decrease the PaCO2

If you want to decrease the PaCO2 in patient conditions where a V/Q mismatch is present, it is not necessary to change the mode.

Proceed as shown in Figure 1 below.

Relevant software: HAMILTON-G5/S1 - v2.6x; HAMILTON-C3 - v2.0x; HAMILTON-C6 - v1.0x

Diagram showing steps to take
Figure 1: Steps for decreasing PaCO2
Diagram showing steps to take
Figure 1: Steps for decreasing PaCO2
Screenshot showing adjustments set to manual
Figure 2: %MinVol adjustments set to manual
Screenshot showing adjustments set to manual
Figure 2: %MinVol adjustments set to manual

Related articles. Get a deeper look

48_PaCO2_PetCO2_Gradient_Target_Shift

PaCO2 - PetCO2 gradient and target shift

INTELLiVENT®-ASV® uses partial pressure of end-tidal CO2 (PetCO2) measured by the CO2 sensor as monitoring input for the regulation of ventilation. The measured PetCO2 value is used to track partial CO2 pressure in the arteries (PaCO2).