Effects of Neurally Adjusted Ventilatory Assist (NAVA) levels in non-invasive ventilated patients: titrating NAVA levels with electric diaphragmatic activity and tidal volume matching

BACKGROUND: Neurally adjusted ventilatory assist (NAVA) delivers pressure in proportion to diaphragm electrical activity (Eadi). However, each patient responds differently to NAVA levels. This study aims to examine the matching between tidal volume (Vt) and patients' inspiratory demand (Eadi), and to investigate patient-specific response to various NAVA levels in non-invasively ventilated patients. METHODS: 12 patients were ventilated non-invasively with NAVA using three different NAVA levels. NAVA100 was set according to the manufacturer's recommendation to have similar peak airway pressure as during pressure support. NAVA level was then adjusted ±50% (NAVA50, NAVA150). Airway pressure, flow and Eadi were recorded for 15 minutes at each NAVA level. The matching of Vt and integral of Eadi (ʃEadi) were assessed at the different NAVA levels. A metric, Range90, was defined as the 5-95% range of Vt/ʃEadi ratio to assess matching for each NAVA level. Smaller Range90 values indicated better matching of supply to demand. RESULTS: Patients ventilated at NAVA50 had the lowest Range90 with median 25.6 uVs/ml [Interquartile range (IQR): 15.4-70.4], suggesting that, globally, NAVA50 provided better matching between ʃEadi and Vt than NAVA100 and NAVA150. However, on a per-patient basis, 4 patients had the lowest Range90 values in NAVA100, 1 patient at NAVA150 and 7 patients at NAVA50. Robust coefficient of variation for ʃEadi and Vt were not different between NAVA levels. CONCLUSIONS: The patient-specific matching between ʃEadi and Vt was variable, indicating that to obtain the best possible matching, NAVA level setting should be patient specific. The Range90 concept presented to evaluate Vt/ʃEadi is a physiologic metric that could help in individual titration of NAVA level.Peer reviewe

Expiratory model-based method to monitor ARDS disease state

INTRODUCTION: Model-based methods can be used to characterise patient-specific condition and response to mechanical ventilation (MV) during treatment for acute respiratory distress syndrome (ARDS). Conventional metrics of respiratory mechanics are based on inspiration only, neglecting data from the expiration cycle. However, it is hypothesised that expiratory data can be used to determine an alternative metric, offering another means to track patient condition and guide positive end expiratory pressure (PEEP) selection. METHODS: Three fully sedated, oleic acid induced ARDS piglets underwent three experimental phases. Phase 1 was a healthy state recruitment manoeuvre. Phase 2 was a progression from a healthy state to an oleic acid induced ARDS state. Phase 3 was an ARDS state recruitment manoeuvre. The expiratory time-constant model parameter was determined for every breathing cycle for each subject. Trends were compared to estimates of lung elastance determined by means of an end-inspiratory pause method and an integral-based method. All experimental procedures, protocols and the use of data in this study were reviewed and approved by the Ethics Committee of the University of Liege Medical Faculty. RESULTS: The overall median absolute percentage fitting error for the expiratory time-constant model across all three phases was less than 10 %; for each subject, indicating the capability of the model to capture the mechanics of breathing during expiration. Provided the respiratory resistance was constant, the model was able to adequately identify trends and fundamental changes in respiratory mechanics. CONCLUSION: Overall, this is a proof of concept study that shows the potential of continuous monitoring of respiratory mechanics in clinical practice. Respiratory system mechanics vary with disease state development and in response to MV settings. Therefore, titrating PEEP to minimal elastance theoretically results in optimal PEEP selection. Trends matched clinical expectation demonstrating robustness and potential for guiding MV therapy. However, further research is required to confirm the use of such real-time methods in actual ARDS patients, both sedated and spontaneously breathing.Peer reviewe

High-fidelity transmission of entanglement over a high-loss freespace channel

Quantum entanglement enables tasks not possible in classical physics. Many quantum communication protocols require the distribution of entangled states between distant parties. Here we experimentally demonstrate the successful transmission of an entangled photon pair over a 144 km free-space link. The received entangled states have excellent, noise-limited fidelity, even though they are exposed to extreme attenuation dominated by turbulent atmospheric effects. The total channel loss of 64 dB corresponds to the estimated attenuation regime for a two-photon satellite quantum communication scenario. We confirm that the received two-photon states are still highly entangled by violating the CHSH inequality by more than 5 standard deviations. From a fundamental point of view, our results show that the photons are virtually not subject to decoherence during their 0.5 ms long flight through air, which is encouraging for future world-wide quantum communication scenarios.Comment: 5 pages, 3 figures, replaced paper with published version, added journal referenc

Performance of lung recruitment model in healthy anesthetised pigs

peer reviewe

Direct generation of photon triplets using cascaded photon-pair sources

Non-classical states of light, such as entangled photon pairs and number states, are essential for fundamental tests of quantum mechanics and optical quantum technologies. The most widespread technique for creating these quantum resources is the spontaneous parametric down-conversion (SPDC) of laser light into photon pairs. Conservation of energy and momentum in this process, known as phase-matching, gives rise to strong correlations which are used to produce two-photon entanglement in various degrees of freedom. It has been a longstanding goal of the quantum optics community to realise a source that can produce analogous correlations in photon triplets, but of the many approaches considered, none have been technically feasible. In this paper we report the observation of photon triplets generated by cascaded down-conversion. Here each triplet originates from a single pump photon, and therefore quantum correlations will extend over all three photons in a way not achievable with independently created photon pairs. We expect our photon-triplet source to open up new avenues of quantum optics and become an important tool in quantum technologies. Our source will allow experimental interrogation of novel quantum correlations, the post-selection free generation of tripartite entanglement without post- selection and the generation of heralded entangled-photon pairs suitable for linear optical quantum computing. Two of the triplet photons have a wavelength matched for optimal transmission in optical fibres, ideally suited for three-party quantum communication. Furthermore, our results open interesting regimes of non-linear optics, as we observe spontaneous down-conversion pumped by single photons, an interaction also highly relevant to optical quantum computing.Comment: 7 pages, 3 figures, 1 table; accepted by Natur

Computer-based monitoring of global cardiovascular dynamics during acute pulmonary embolism and septic shock in swine

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