Flow-Controlled Ventilation - How it works?

An emerging ventilation technique to linearize expiratory flow is flow-controlled ventilation (FCV), provided by the new ventilator Evone (Ventinova Medical B.V., Eindhoven, the Netherlands).

This device provides a constant positive flow during inspiration and a constant negative flow during expiration. Thereby pressure increases linearly during inspiration [comparable to volume-controlled ventilation (VCV)] and decreases linearly during expiration. Linearizing the expiratory flow improved lung recruitment, the homogeneity of lung aeration, gas exchange and further attenuated experimental lung injury.

Moreover, Evone enables the use of an ultra-thin tube, with an outer diameter of only 4.4mm: Tritube (Ventinova Medical B.V., Eindhoven, the Netherlands).

Filauro et al., recently published a nice case series based of their initial experience with Evone and Tritube. The images in attach, clearly show the advantage of using such device.

(A-C) preoperative office flexible view of idiopathic subglottic stenosis (Cotton-Myer grade III); (B-D) the tritube provides minimal traumatic intubation and guarantees an ideal working space and exposure by maintaining stable ventilation; (E) an advanced case of RRP (Derkay site score: 12; Derkay clinical score: 7); (F) this difficult intubation can be achieved by small-lumen ventilation, such as Evone^®. This latter, compared to HFJV, protects against aerosolisation of papillomavirus in the operating theatre; (G) the larynx of a patient repeatedly treated for RRP with a posterior glottic stenosis (Bogdasarian II); (H) the use of a narrow tube allows the treatment of the posterior compartment of the larynx, despite the presence of the posterior web.