Hindawi

Journal of Healthcare Engineering

Volume 2022, Article ID 2507149, 7 pages
https://doi.org/10.1155/2022/2507149

Research Article
Application of Different Ventilation Modes Combined with
AutoFlow Technology in Thoracic Surgery

Wang Lixian , Yang Yanfang, Cui Chengzong, Jiang Ning, and Guo Yufeng
Cangzhou Central Hospital, Cangzhou, China

Correspondence should be addressed to Wang Lixian; wanglixian@mail.chzu.edu.cn

Received 16 January 2022; Accepted 10 March 2022; Published 28 March 2022

Academic Editor: Deepak Kumar Jain

Copyright © 2022 Wang Lixian et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

To investigate the effect of AutoFlow on airway pressure and hemodynamics in mechanical ventilation constant volume-control
ventilation mode, 100 patients receiving mechanical ventilation were randomly divided into observation group (SIMV-PSV-
PEEP + AutoFlow) and control group (SIMV-PSV-PEEP). The results showed that the peak airway pressure and average airway
pressure decreased with different flow rate settings and automatic flow conversion (P < 0.05). The peak airway pressure and mean
airway pressure decreased with different resistance settings (P < 0.05). With different compliance settings, the peak airway
pressure and average airway pressure decreased after being assisted with an automatic converter (P < 0.05). Adding AutoFlow on
the basis of SIMV-PSV mode can significantly reduce peak inspiratory pressure (PIP), mean airway pressure (Pmean), and airway
resistance (R). There was no significant difference in hemodynamic monitoring results between the observation group and the
control group. It is proved that the SIMV constant volume-controlled ventilation mode combined with AutoFlow can not only
ensure tidal volume but also avoid excessive airway pressure, which has little effect on hemodynamics.

1. Introduction constant pressure, improper pressure adjustment, or in-

At present, ventilator technology tends to mature and the
application level of clinicians is stable. Mechanical venti-
lation has been widely used and has become an important
means of clinical treatment and rescue of critically ill pa-
tients. With the accumulation of clinical experience and the
application of microcomputer technology, some new me-
chanical ventilation modes and technologies have been
developed and applied, such as: its common features are that
compared with the previous auxiliary ventilation mode, it is
closer to the physiological state, more in line with the actual
respiratory mechanical characteristics and pathophysiology
of patients, and more humanized. Under the condition of
meeting the ventilation, it aims to make patients comfortable
to the greatest extent, pay more attention to preserving
patients’ autonomous breathing function, improve man-
machine coordination as much as possible, minimize pa-
tients’ respiratory work, and avoid complications related to
artificial respiration support [1, 2]. Traditional fixed pressure
ventilation mode BiPAP is applied to neonates. Because of
creased airway resistance, it is easy to lead to insufficient
ventilation, causing hypoxemia and carbon dioxide reten-
tion. The auxiliary ventilation technology combined with
SIMV + AutoFlow can dynamically adjust the air flow
according to the patient’s current airway pressure and chest-
lung compliance and send the preset tidal volume with a
deceleration wave and the lowest pressure, which can make
up for the deficiency of the BiPAP mode [3].
2. Literature Review
Ge et al. believed that thoracoscopy is a new technology
applied in thoracic surgery in recent years. Under the direct
vision of a high-definition television imaging system, the
operation system is inserted into the chest through chest wall
incision to diagnose and treat chest diseases. This operation
has the advantages of small incision, small injury, and fast
recovery and can be widely used in clinics [4]. Campos and
Sharma believed that patients with primary bronchial lung
cancer (referred to as lung cancer) and chronic obstructive
2 Journal of Healthcare Engineering
pulmonary disease (COPD) had common risk factors, such
as smoking, so many lung cancer patients were diagnosed
with COPD in the preoperative pulmonary function as-
sessment of thoracoscopy [3]. Hahm believe that patients
often have complications such as pulmonary infection and
atelectasis after thoracoscopic surgery due to low ciliary
function, which increases the length of hospital stay, so it
puts forward higher requirements for nursing work [5].
Gedik and Alar believed that each pressurization of the
oscillating sputum drainage system can force the air flow to
quickly pass through the lung tissue, stimulate the cilia
through the chest wall oscillation, improve the cilia swing
frequency, promote the secretion to fall off from the trachea
and bronchus and move to the oral cavity, and discharge it
through normal cough or negative pressure sputum suction
after reaching the oral cavity [6]. Meng et al. believed that
this method is suitable for patients with pulmonary insuf-
ficiency caused by difficulty in excreting pulmonary secre-
tions or mucus blocking the lungs and can promote airway
clearance and sputum excretion or improve bronchial
drainage. Therefore, it can reduce the incidence of pul-
monary infection and atelectasis in patients with lung cancer
complicated with COPD [7]. Habertheuer et al. thought that
volume-controlled ventilation (VCV) and pressure-con-
trolled ventilation (PCV) are commonly used in mechanical
ventilation (MV). VCV and PCV have their own advantages
and disadvantages. The main advantage of VCV is to ensure
tidal volume, while PCV has obvious advantages in reducing
the risk of barotrauma, improving human-machine coor-
dination, reducing patients’ respiratory work, and im-
proving gas distribution in the lung and ventilation blood
flow ratio [8]. Park believes that the automatic flow function
of the ventilator is a kind of dual control mode. The dual
control mode attempts to combine the advantages of VCV
and PCV. Some studies have compared the differences
between other dual control modes and traditional constant
current air supply VCV and PCV. It is considered that the
advantages of a dual control mode are as follows: while
ensuring the tidal volume, it avoids the disharmony between
the air supply flow rate caused by the fixed VCV flow rate
and the needs of patients, improves the man-machine
synchronization, reduces the patient’s respiratory work,
reduces airway pressure, improves gas exchange, and is safer
for patients with unstable ventilation. However, few studies
comprehensively compare the changes of airway pressure,
flow rate, and other respiratory mechanical indexes after
auxiliary automatic conversion [1]. George et al. believed
that the study of a model lung can set different compliance,
resistance, and inspiratory flow rate and exclude the in-
fluence of patients’ breathing mode and other clinical
conditions. It has good repeatability and is an ideal method
to study respiratory mechanics [9]. Rohde et al. believed that
AutoFlow is an auxiliary ventilation technology combined
with the SIMV mode. It is not an independent ventilation
mode, but a functional extension of the capacity control
breathing mode [10]. Dearani et al. believed that after using
AutoFlow, the ventilator will dynamically adjust the air flow
according to the patient’s current airway pressure and chest
lung compliance and send it to the preset tidal site with the
velocity waveform of deceleration wave and the lowest
pressure, so as to avoid the occurrence of barotrauma to the
greatest extent. At the same time, the patient is allowed to
breathe freely in the whole ventilation cycle, and the man-
machine coordination is better. If the airway resistance and
chest-lung compliance change, the airway pressure shall be
increased or decreased by 3 cm H2O each time, but not
higher than 5 cm H2O below the set pressure alarm high
limit, otherwise the pressure and tidal volume alarm [11].
Based on the current research, in order to explore the
effect of AutoFlow on airway pressure and hemodynamics in
mechanical ventilation constant volume control ventilation
mode, 100 patients receiving mechanical ventilation were
randomly divided into observation group (SIMV-PSV-
PEEP + AutoFlow) and control group (SIMV-PSV-PEEP).
3. Materials and Methods
3.1. Clinical Data. From January 2019 to January 2021, 100
patients with respiratory failure received mechanical ven-
tilation in the respiratory intensive care unit (RICU) of our
hospital, including 75 males and 25 females. All patients
underwent oral endotracheal intubation or tracheotomy
after admission to the RICU and were mechanically ven-
tilated with the Drager EVTA 4 ventilator. The ventilation
mode was SIMV pressure support ventilation (PSV)-positive
end expiratory pressure (PEEP) [12].
3.2. Method
3.2.1. When Transferred to ICU. In a randomized controlled
study, the included children were randomly divided into
groups A and B according to the random number table.
Group A represents the BiPAP group and group B represents
the SIMV + AutoFlow group. After general anesthesia, the
subjects of the two groups were transferred to the ICU under
stable respiratory and circulatory conditions, such as body
temperature, heart rate, blood pressure, oxygen saturation,
central venous pressure (CVP), respiratory rate, tidal vol-
ume, and peak airway pressure and resistance, and me-
chanical ventilation was given with the German Drager
EVTA 4 ventilator.
3.2.2. Breathing Mode Using Ventilator. BiPAP ventilation
mode parameter setting: determine the tidal volume (VT) by
adjusting the difference between Phigh and Plow according to
the patient’s weight, which is generally calculated as TV � 8 ∼
10 ml/kg. The preset respiratory rate is 25 ∼ 40 times/min.
Adjust the inspiratory time to determine the inspiratory
respiratory ratio (I:e), usually 1 : 1 or 1 : 2; Phigh is usually 15 ∼
20 cm H2O, plot is 5 ∼ 7 cm H2O. SIMV + AutoFlow ven-
tilation mode parameter setting: the respiratory rate is
usually 25 ∼ 40 times/min, VT � 8 ∼ 10 ml/kg, the tidal
volume is set, the breathing ratio is set from 1 : 1 to 1 : 2, and
the positive end expiratory pressure (PEEP) is generally set
at 0 ∼ 3 cm H2O. The support pressure (PSV or PASB) is
generally adjusted to 10 ∼ 20 cm H2O. After the ventilator is
connected with the patient, the ventilation parameters are
Journal of Healthcare Engineering 3

adjusted appropriately according to the specific condition
[13].
3.2.3. Offline Standard. When the patient is awake and
cooperative, spontaneous breathing is stable, cough and
swallowing reflexes are recovered, the respiratory tract is
unobstructed, circulation is stable, and the internal envi-
ronment is balanced. It is expected that there is no possibility
of reoperation and endotracheal intubation, and the offline
steps can be implemented when the blood gas analysis Pao
is > 60 mmHg, PaCO2 is < 50 mm Hg, and FiO2 is ≤ 40%.
3.2.4. Offline Steps. Firstly, reduce the inhaled oxygen
concentration to less than 40%, and then, gradually adjust
the support pressure to less than 5cmho. The respiratory rate
in the SIMV mode is gradually reduced to less than 5 times
per minute, the Phigh in the BIPAP mode is gradually re-
duced, the Plow is synchronously reduced, and the reduction
can be stopped when it reaches 3 cm H2O. When the dif-
ference between Phigh and Plow is reduced to 5 ∼ 7 cm H2O, it
can be changed to CPAP or maintained at 5 cm H2O and the
PASB can be synchronously reduced to less than 5 cm H2O.
Observe for 30 minutes after the trial shutdown and measure
the arterial blood gas analysis (including arterial blood gas
pH value, arterial blood oxygen partial pressure, arterial
blood carbon dioxide partial pressure, blood oxygen satu-
ration, and BE value). The patient’s blood pressure, heart
rate, and respiration are stable. Endotracheal intubation was
pulled out, and oxygen was absorbed by a mask. After
tracheotomy, patients were removed from the machine,
oxygen was directly absorbed by gas cut masks to ensure
normal blood oxygen saturation [14].
3.3. Observation Indicators. Monitoring indicators include
the following: (1) record the general information of patients
after admission to the ICU, including patient name, gender,
age, weight, hospitalization number, admission diagnosis,
operation status, operation name, and cardiopulmonary
bypass time and (2) after admission to the ICU, each patient
was continuously monitored for basic vital signs, including
body temperature, blood pressure, heart rate, pulse, respi-
ratory rate, and blood oxygen saturation. After admission,
routine arterial blood gas analysis was given. Vital signs,
blood gas (pH, PaCO2, and PaO2), and ventilator indexes,
including respiratory rate (f ), tidal volume (VT), peak
airway pressure (Ppeak), lung compliance (c), airway resis-
tance (R), and minute ventilation (MV), were recorded at
five time points of admission (t0), 30 minutes (t1), one hour
(t2), two hours (t3), and three hours (t4).
3.4. Statistical Treatment. All data were processed by PEMs
3.1 medical statistics software package, the observation data
were expressed by X ± s, and the paired t-test was used for
comparison between groups. P < 0.05 was statistically
significant.
Table 1: Respiratory mechanics results of two groups (x ± s).
Number of
Group PIP Pmean R VT
cases
Observation
50 28 ± 5 27 ± 4 40 ± 18 589 ± 70.1
group
Control group 50 15 ± 4 9 ± 4 26 ± 14 574 ± 79.9
P value <0.01 <0.05 <0.05 >0.05
Table 2: Blood gas and hemodynamic results of two groups.
Number of
Group HR ABPM PH PaO2
cases
Observation
group
50 95 ± 11 74 ± 12 6.9 ± 0.1 87 ± 13
Control group 50 92 ± 10 72 ± 10 6.9 ± 0.1 91 ± 16
P value >0.05 >0.05 >0.05 >0.05
4. Results
The respiratory mechanics results of the two groups are
shown in Table 1. Table 1 shows that PIP and Pmean in the
observation group decreased significantly and R decreased
significantly compared with the control group. There was no
significant difference in VT between the observation group
and the control group. The results of hemodynamics and
arterial blood gas analysis of the two groups are shown in
Tables 2 and 3. It can be seen from Tables 2 and 3 that there is
no significant difference in arterial blood gas analysis results
and hemodynamic monitoring results between the two
groups [15].
A total of 100 children were enrolled. The longest
transfer time was 137 minutes, and the longest use time of
ventilator was 40 hours and the shortest was 5 hours. Five
cases died recently after operation, including 3 cases of low
cardiac output syndrome, 1 case of arrhythmia, and 1 case of
pulmonary infection.
Two independent samples t-test was used for the general
data of the two groups. Among the 100 patients observed,
there was no significant difference in age, weight, transit
time, blocking time, vital signs, and ventilator monitoring
indexes between the two groups (P > 0.05).
The intragroup comparison showed that there was sig-
nificant difference in peak airway pressure at different time
points in patients with the same mechanical ventilation
mode with time (P < 0.05). It can be seen from the figure that
the peak airway pressure of children applying the
SIMV + AutoFlow mechanical ventilation mode is lower
than that of the BiPAP group and shows a downward trend
(see Figure 1 for the results) [16]. At the same time, the
alveolar compliance was different at different time points
(P > 0.05) (see Figure 2 for the results).
The delivered tidal volume remained unchanged before
and after auxiliary automatic conversion (500 ± 1.3 ml vs,
500 ± 1.2 ml, P > 0.05). After auxiliary automatic conversion,
peak airway pressure and average airway pressure decreased
(P < 0.05) (see Figure 3).
4 Journal of Healthcare Engineering

Table 3: Blood gas and hemodynamic results of the two groups.

Group Number of cases PaCO2 CVP CO SV
Observation group 50 43 ± 10 14.8 ± 3.1 7.6 ± 0.9 65 ± 10.4
Control group 50 41 ± 9 15.4 ± 3.0 7.8 ± 0.8 65 ± 8.9
P value >0.05 >0.05 >0.05 >0.05

50
17.5

Airway pressure (cm water column)

40
Estimated Marginal Means

17.0

30
16.5

20
16.0

10
15.5

0
0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 The airway peak pressure Mean airway pressure
Time (h)
Auxiliary white dynamic flow converter before
Observation group
The control group Auxiliary white dynamic variable flow

Figure 1: Change in the trend of peak airway pressure in the Figure 3: Peak and average airway pressure before and after
SIMV + AutoFlow group at different time points. auxiliary automatic conversion.

settings, the peak airway pressure and average airway

34
pressure decreased after assisted automatic flow conversion
32 (P < 0.05) (see Figures 8 and 9).
Estimated Marginal Means

30
28
26
24
22
20
18
16
1.0 1.5
Observation group
The control group
Figure 2: Change in the trend of lung compliance in the
SIMV + AutoFlow group at different time points.
On the premise that the conveying moisture volume
remains unchanged (P > 0.05), with different flow rate set-
tings, the peak airway pressure and average airway pressure
decreased after auxiliary automatic flow conversion
(P < 0.05) (see Figures 4 and 5); with different resistance
settings, the peak airway pressure and average airway
pressure decreased after auxiliary automatic flow conversion
(P < 0.05) (see Figures 6 and 7); with different compliance
5. Discussion
Mechanical ventilation modes can be divided into two
categories: constant pressure ventilation and constant vol-
ume ventilation (SIMV). Compared with constant pressure
ventilation, the advantage of constant volume ventilation is
that it can ensure the preset tidal volume; the doctor presets
the VTdelivered by the command breathing mode, and then,
the ventilator delivers the predetermined VT regardless of
resistance and compliance. The proximal airway pressure of
2.0 2.5 3.0 3.5 4.0
patients changes. If the airway resistance increases or the
Time (h) respiratory compliance decreases, it can cause high peak
airway pressure and plateau pressure, resulting in excessive
expansion of localized alveoli and barotrauma [17]. The data
of this group showed that after SIMV combined with
AutoFlow, the peak inspiratory pressure and average airway
pressure decreased significantly and the airway resistance
decreased, indicating that AutoFlow can improve respira-
tory mechanics to a certain extent. AutoFlow itself is not an
independent ventilation mode. As a pressure regulation
function extension of the volume-controlled breathing
mode, it combines the advantages of pressure-controlled
ventilation and volume-controlled ventilation when used in
combination with the SIMV mode. The working principle is
as follows: at the beginning of the ventilator, four consec-
utive experimental breaths with a pressure of 10 cm H2O are
Journal of Healthcare Engineering 5

60 70

55
Airway pressure (cm water column)

Airway pressure (cm water column)

60
50

45 50

40
40
35
30
30

25 20

20
10
30 35 40 45 50 55 R1 R2 R3 R4 R5 R6
Time (min)
Auxiliary white dynamic flow converter before
Auxiliary white dynamic flow converter before Auxiliary white dynamic variable flow
Auxiliary white dynamic variable flow
Figure 6: Changes in peak airway pressure before and after
Figure 4: Changes in peak airway pressure after auxiliary auto- auxiliary automatic conversion under different resistance settings.
matic conversion under different flow rate settings.

12.5 14
Peak airway pressure (cm water column)

12.0 13
Airway pressure (cm water column)

11.5 12

11.0 11

10.5
10

10.0
9.5
9.0
30 35 40 45 50
Time (min)
Auxiliary white dynamic flow converter before
Auxiliary white dynamic variable flow
Figure 5: Changes in mean airway pressure after auxiliary auto-
matic conversion under different flow rate settings.
performed, and the current airway pressure and lung-chest
compliance of the patient are continuously measured by a
microcomputer. According to the volume-pressure rela-
tionship, calculate the suction pressure required for the next
ventilation to reach the preset tidal volume, automatically
adjust the preset suction pressure level (usually adjusted to
75% of the calculated value), and send the preset tidal
volume with the velocity waveform of deceleration wave and
the lowest pressure so as to make the actual tidal volume
consistent with the preset tidal volume and avoid the oc-
currence of air pressure injury to the greatest extent [18, 19].
At the same time, the patient is allowed to breathe freely
throughout the ventilation cycle. The inspiratory pressure
level can be automatically adjusted within the range of
5 cm H2O when the end expiratory airway pressure reaches
9
8
R1 R2 R3 R4 R5 R6
55 Auxiliary white dynamic variable flow
Auxiliary white dynamic flow converter before
Figure 7: Changes in mean airway pressure before and after
auxiliary automatic conversion under different resistance settings.
the preset inspiratory upper limit pressure level, but each
adjustment range is less than 3 cm H2O, otherwise the
pressure and tidal volume alarm. The main advantages of
SIMV combined with AutoFlow are as follows: good man-
machine coordination can reduce or avoid the use of sed-
atives or muscle relaxants; it can automatically adjust the
inspiratory pressure according to the monitoring indicators
of lung function and meet the preset tidal volume with the
lowest airway pressure, which is conducive to the prevention
of barotrauma. The waveform of air flow velocity is a de-
celeration wave. When the airway is blocked, it can reduce
eddy current, so as to reduce pressure consumption and
reduce inspiratory peak pressure [20, 21].
AutoFlow is suitable for some patients with respiratory
failure (such as acute respiratory distress) and high airway
resistance (such as critical asthma). According to the actual
6 Journal of Healthcare Engineering

pressure and increase lung compliance. Peak airway pressure

45 decreases and lung compliance increases with time. Using
Peak airway pressure (cm water column)

the BIPAP mode and the SIMV + AutoFlow breathing mode,

40
there was no significant difference in arterial blood gas, tidal
volume, minute ventilation, and airway resistance.
35
SIMV + AutoFlow is a safe and reliable mechanical venti-
lation mode for patients with congenital heart disease and
30
deformity after correction.
25
Data Availability
20
The data used to support the findings of this paper are
available from the corresponding author upon request.
15

C1 C2 C3 C4 C5 C6 C7 Ethical Approval
Auxiliary white dynamic variable flow In this manuscript, all procedures comply with the inter-
Auxiliary white dynamic flow converter before
national code of ethical conduct for biomedical research
Figure 8: Changes in peak airway pressure before and after involving human subjects (CIOM) and the Declaration of
auxiliary automatic conversion under nonreturn compliance Helsinki. The experimental protocol was approved by the
modification. Institutional Review Committee (IRB) of Cangzhou Central
Hospital.
12.5
Consent
12.0
Auxiliary white dynamic variable flow

All participants provided written informed consent.

11.5

11.0 Conflicts of Interest

10.5
10.0
9.5
9.0
8.5
C1
Auxiliary white dynamic flow converter before
Auxiliary white dynamic variable flow
Figure 9: Changes of mean airway pressure before and after
Fuchuan automatic conversion under different compliance
settings.
situation of the patient, on the premise of avoiding air
pressure injury, the preset inspiratory upper limit pressure
level should not be too low; otherwise, it can be difficult to
reach the preset tidal volume because the range of inspiratory
pressure automatically adjusted by the computer is too small
[22]. The data of this group show that there is no significant
difference in hemodynamic monitoring parameters between
the observation group and the control group after being
combined with AutoFlow, indicating that SIMVP combined
with AutoFlow has little effect on hemodynamics [23–25].
6. Conclusion
Compared with BiPAP, the SMV + AutoFlow mechanical
ventilation mode can significantly reduce peak airway
The authors declare that they have no conflicts of interest.
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