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Room to breathe
in
volume-oriented
ventilation
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What is Autoflow
Volume targeted, pressure controlled
ventilation
2 Essential elements:
Active exhalation valve to allow for spontaneous breathing
Pressure regulation algorithm to deliver set tidal volume with
minimum pressure according to changes in patients compliance and
resistance
I t is an adjunct that is activated with volume modes of I PPV/
SI MV / MMV
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How Autoflow works
time
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Pressure limitation
AutoFlow

offers automatic
adjustment of the flow rate to deliver
the set volume with the least possible
pressure
Reduced Peak pressures
Inspiration flow automatically
adjusted to changes in lung condition
and spontaneous breathing demand
of patient

Pressure changes occur in steps of 3
mbar till target Vt is achieved
The patient can breathe
spontaneously during all phases
of the ventilatory cycle
spontaneous breathing during
mandatory inspiration does not alter
the plateau pressure as inspiratory
and expiratory flow are adapted to
patients demand
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Settings for Autoflow
Vt target tidal volume for patient
Ti Inspiratory time
Freq Number of mandatory breaths ventilator delivers
PEEP End Expiratory pressure to maintain FRC
Rise time to decide how fast Pinsp is achieved in the
inspiratory phase
FiO2 according to patients needs
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Important alarm limits in Autoflow
Paw limit This is the maximum pressure the ventilator algorithm will
use to deliver target Vt.
If unable to deliver target Vt with Pinsp increased to Paw limit
a visual alarm VOLUME NOT CONSTANT
will be displayed on the screen together with audible alarm
The significance of this alarm indicates the
deteriorating lung condition of the patient
and must be treated as high priority.
Patient needs assessment
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Vti ( Inspiratory Tidal volume )
This limit should be set close to target Vt
When this limit is met, inspiratory phase
will be terminated
This helps prevent volutrauma as
lung condition improves
Important alarm limits in Autoflow
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Minute volume - High and Low limits
Set Upper and lower MV alarm to avoid excessive or insufficient flow
following rapid changes in compliance

Important alarm limits in Autoflow
Frequency :
To detect increase WOB in patients due to reduced pressure support
in response to their high inspiratory demands
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Why Autoflow
Open Breathing System
Allows for spontaneous breathing with all the documented benefits
To minimise Airway Pressures
Spontaneous breathing allows use of lower MAP
To maximise benefits of Prolonged Ti
Longer Ti can aid in rcruitment
Automatic adjustments of Pinsp
The lowest Pinsp is used to deliver target Vt as lung condition
changes
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When not to use Autoflow
When Oxygenation is an issue:
Maintenance of MAP is critical
Autoflow delivers Vt at minimal pressure which can lower MAP
Patients with high inspiratory demands
Patients with high inspiratory demands are mistaken as improving in
compliance leading to decreased pressure support in Autoflow
Patient compensates for decreased support with increase WOB
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What to Observe in AutoFlow

Peak pressure decreases; flow decelerates
P
insp
adjusts to compliance changes and is minimized
No high Paw alarm during spontaneous breathing
Spontaneous breathing activity can be observed in flow
curve
Paw
Pinsp. = f (VT,C)
PEEP
t
TI
1
Paw
TE
Flow
t
f
without spontaneous breathing with spontaneous breathing
V
T
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AutoFlow

- The Advantages
Reduced peak pressures
Less mechanical invasiveness
Weaning is no longer a challenging battle
Less sedation and fewer muscle relaxants ( cost saving )
Spontaneous breathing leads to improved gas exchange (coughing is
better tolerated)
More patient comfort, less stress in the ICU (fewer alarms)
patient activity
Patient
Paw
t
t
patient activity
Patient
Paw
t
t
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SIMV with Autoflow activated