Tracheal pressure ventilator control

Tracheal pressure ventilator control (TPVC) is a ventilator mode that relies on tracheal pressure at the carinal end of the endotracheal tube for triggering the ventilator ;;on,'' controlling pressure, and cycling the ventilator ;;off.'' TPVC automatically nullifies imposed resistive work of the breathing apparatus (endotracheal tube plus ventilator) by providing automatic and variable levels of pressure assist. TPVC improves ventilator responsiveness for a spontaneously breathing patient by providing significantly higher peak inspiratory flow rates much closer to that demanded by a patient. TPVC also provides higher assist pressures and flow rates earlier in the breath and thus better-match ventilator-supplied flow to patient-demanded flow than an equivalent level of pressure support ventilation. Matching patient demand for flow to ventilator supply of flow, early in the breath, promotes patient-ventilator synchrony and minimizes work of breathing. We recommend moving the pressure-triggering and control site to the carinal end of the endotracheal tube to provide TPVC.