Talk:Modes of mechanical ventilation

information merging

merged high frequency ventilation into this article. if there are any other articles that should be merged, post the merge thing to their talk pages and lets get this article complete and comprehensive! Je.rrt (talk) 22:56, 26 August 2011 (UTC)

Modes to be included soon

— Preceding unsigned comment added by Je.rrt (talk • contribs) 03:34, 27 August 2011 (UTC)

Positive End-Expiratory Pressure

PEEP - coming soon

Adaptive Support Ventilation

ASV - coming soon

Proportional Assist Ventilation

PAV - coming soon

Inverse Ratio Ventilation

IRV -

Volume Ventilation +

VVP - coming soon

format? this definiately needs a better format for comprehension and this is an idea

MODE - Mode introductory explaination in its most basic function. Futher explaination regarding alternative names of the mode. An advanced explaination of the physics regarding ventilation in this mode is great but language needs to be basic.

Uses for this mode and why. Indications and contraindications for this mode and why. Additional considerations would go here too.

Variables related to the mode and now they apply to the mode.

Expected outcome with the use of this mode

Je.rrt (talk) 17:02, 5 September 2011 (UTC)

I think that it's a good idea to have a consistent format for the modes. I think that the summaries on this page should be concise, perhaps with examples to illustrate the explanation of the mode, but that most of the information should be on the main page for each mode. Second, I'm confused with regard to how PRVC is presented throughout these pages. Most of what is written refers to it as an IMV mode. In my experience, PRVC has never had a spontaneous breathing component. The only relationship that I can see between PRVC and IMV is if it is used as an adjunct to SIMV. But then we aren't talking about pure PRVC. Thoughts? Cglion (talk) 16:12, 27 November 2011 (UTC)

PRVC is an IMV mode. Meaning that the major difference between CMV and IMV (nomenclature is trying to replace SIMV with IMV because there hasnt been a difference since ~1985) is pretty much just patient breath support. CMV delivers a full breath volume and pressure on a schedule and with patient initiation; whereas IMV only gives a full breath on a schedule and supports patient breaths by way of pressure support or just straight PEEP. PRVC is an IMV mode by definition; setting a tidal volume goal with a pressure limit "pressure regulated volume control". Different ventilators fail appropriate nomenclature and cause confusion (ive seen PRVC-IMV) but the accepted nomenclature is fairly straight forward. Pulmonological (talk) 01:48, 28 November 2011 (UTC)

I understand the difference between CMV and IMV as you defined them. No problem there. Where I don't understand/disagree with what you have said is the fact that PRVC is IMV "by definition". In my experience, PRVC has no pressure support component. Every breath (patient or machine initiated) is fully supported by the ventilator. That seems to disagree with your statement that "IMV only gives a full breath on schedule and supports patient breaths by way of pressure support or just PEEP" [although note that I do agree with this definition of IMV]. Maybe the two PRVC modes that we have been using are functionally different? Cglion (talk) 19:51, 17 December 2011 (UTC)

restructure

I think it should be restructured to be a little easier to understand:

Intermittent mandatory ventilation

Pressure-controlled

Mode within this section

Pulmonological (talk) 17:54, 20 October 2011 (UTC)

cycles

We probably need to talk about ventilator cycling as its own section, where we talk about patient cycle, time cycle, pressure cycle, volume cycle etc. That way the further reading down the article makes more sense about the different modes that exist (Pressure-control CMV vs Volume-control CMV). We also need to rewrite a lot of this to represent current nomenclature but without having to mention the several other previous used terms every time we do. Pulmonological (talk) 12:33, 17 December 2011 (UTC)

I agree. Cglion (talk) 21:05, 17 December 2011 (UTC)

major modifications

This article is much more structured but it is still not as clear and misleading on some topics | pulmonological ^{talk • contribs} 22:08, 12 July 2012 (UTC)

I agree - and yet I fail to contribute to this article. Would you know why the anonymous writer continues to delete my inputs (see history)? Josef X Brunner (talk) 08:19, 3 March 2025 (UTC)

A mode is more than inspiration

Currently, a mode is defined as "The mode refers to the method of inspiratory support." I suggest to change it because a mode includes expiratory phases as well. The issue is discussed, for example in https://derangedphysiology.com/main/cicm-primary-exam/respiratory-system/Chapter-541/modes-and-targeting-schemes-mechanical-ventilation . One example: BiPAP allows for breathing at different levels of airway pressure and is both, inspiratory support as well as expiratory support. Another example is APRV, designed to support ventilation by intermittent exhalation support, thus the name Airway Pressure Release Ventilation. Josef X Brunner (talk) 09:58, 2 March 2025 (UTC)

Lawsuits

There has been some back-and-forth editing about who invented ASV. Here are the two versions from recent edits, broken up so we can talk about them by numbers:

Comparison of two versions

"Hamilton" version

"Tehrani" version

Adaptive Support Ventilation (ASV) is a mode that adapts to the pulmonary mechanics of the connected patient. It was commercialised by Hamilton Medical under the name ASV. The invention was claimed by different parties and was fought in courtwith a final verdict in favour of Hamilton Medical. In the ASV mode, every breath is synchronized with patient effort if such an effort exists, and otherwise, full mechanical ventilation is provided to the patient. In contrast to other modes, the clinician sets the percent of normal minute ventilation and ASV partitions this input into tidal volume and rate settings. The goal is to keep work of breathing at a minimum. Later, this idea was modified to keep Mechanical Power of ventilation at a minimum called "Adaptive Ventilation Mode" and marketed by Vyaire.

Adaptive Support Ventilation (ASV) is the only commercially available mode that uses optimal targeting. This ventilation mode was invented and subsequently patented in 1991 by Dr. Fleur Tehrani In this positive pressure mode of ventilation, the frequency and tidal volume of breaths of a patient on the ventilator are automatically adjusted and optimized to mimic natural breathing, stimulate spontaneous breathing, and reduce weaning time. In the ASV mode, every breath is synchronized with patient effort if such an effort exists, and otherwise, full mechanical ventilation is provided to the patient.

Sources
References

Two initial thoughts:

• Most of this is more or less the same. We could just remove the disputed material entirely. Most Wikipedia articles don't bother with company names, trademarks, inventors, etc.
• Several of these citations are old (1994, 2001, 2003...) or weak (e.g., WP:PATENTS).

What do you think? WhatamIdoing (talk) 17:36, 10 May 2025 (UTC)

Great idea WhatamIdoing, remove the disputed material and describe the process of ASV. Like Lova Falk (talk) 05:01, 11 May 2025 (UTC)

Thank you for this effort. Highly appreciated.

First, there is no "Hamilton" involved in this discussion. I was indeed working for Hamilton 17 years ago but have no contact with the company anymore and, most importantly, I am not commissioned by the company, no money, no benefits, nothing. I am just interested to keep the facts straight.

Point 1 Hamilton' ASV is not unique anymore. "Tehrani" claims that the mode is "the only commercially available mode that uses optimal targeting". This is incorrect.

Point 2 in "Hamilton" explains transparently that there was a dispute and that there are court verdicts, all available in public. I agree, we can remove the name of the "winner" from the page. "Therani" claims invention - which anybody could do. However, fact is (see Reference under "Hamilton") that Therani sued Hamilton to infringe on ther patent. Initially, a county judge ruled the case in favour of Tehrani in a summary judgment motion. Hamilton appealed in US Federal Circuit who reverted the ruling of the county judge (also available on the web). The case was sent back to the same county judge and Hamilton pushed to find an out-of-court settlement. In other words, the case was not lost in court. However, Tehrani apparently continued to sue Hamilton and this time, Hamilton obviously fought back hard with a final verdict in favour of Hamilton. The Wiki entry "Therani" does not reflect this fact. The "Hamilton" entry reflects the fact without mentioning the name Tehrani.

Point 3 in "Tehrani" falls short of explaining the intricacies of the mode. ASV does not copy natural breathing because in disease, "natural breathing" is not desired but rather a breath pattern that minimizes lung injury. ASV does not stimulate spontaneous breathing but may be set to create a chemical stimulus. Finally, weaning is not the primary goal, but of course the last phase of the mechanical ventilation process.

Point 4 in "Hamilton" explains the evolution of the initial ASV mode. "Tehrani" claims that ASV is the only mode with optimal breath pattern. Of course we can remove Vyaire.

By the way, the IP has reverted the revert of Lova Falk - Please let me know how to proceed. Josef X Brunner (talk) 11:28, 11 May 2025 (UTC)

Josef X Brunner Feel free to revert! If the IP user reverts more than three times within 24 hours, and with their refusal to discuss, you can, if you want to, add a report to the administrator's noticeboard. Be sure, before you do this, to give the ip editor a warning on their talk page. Read here: WP:3R. I'll soon log out for today, so I cannot discuss this further with you today. Friendly, Lova Falk (talk) 12:24, 11 May 2025 (UTC)

@Josef X Brunner, I recommend that you don't revert back, since that could get you in trouble as well. (Sometimes the volunteer admins take a "block everyone" approach.) I've asked for page protection, which (assuming they grant it) will stop the distraction of ongoing reverting. I've also removed the sentences containing Tehrani's name (but left the rest, and some of the sources). I hope that, in the short-term, not having the Wrong™ name in the article will reduce the urgency around trying to get the Right™ name in the article.

I don't know much about mechanical ventilation. Do you have a favorite book(s) that you would recommend? I'm hoping to find something that's generally sound and that discusses different options in depth. For example, would you recommend the Oxford Handbook of Respiratory Medicine https://academic.oup.com/book/40437 ? I've got free online access to that one,[1] but I don't know anything about it. WhatamIdoing (talk) 22:53, 11 May 2025 (UTC)

Thank you for the great help. As you can see, the IP keeps changing things, it looks like someone is protecting this article for some hidden reason.

There are many books on modes of ventilation and there is quite a confusion about terminology. In the current article, we have a number of problems, many of minor importance but some of potenially large impact when it comes to statments like "the only commercially available mode that uses optimal targeting" which is bluntly false and may mislead readers, or "Mechanical ventilation machines are available with both invasive modes (such as intubation).." wich again is incorrect because "intubation" is not a mode.

In general, the language is not really comprehensive and the entire chapter would profit from re-writing. So eliminating the article in total might create an opportunity for a new start. Josef X Brunner (talk) 07:54, 12 May 2025 (UTC)

The current structure looks like this:

1. Taxonomy for mechanical ventilation (e.g., the 10 maxims)
2. Descriptions of common modes
3. Spontaneous breathing and support settings
4. Other ventilation modes and strategies

Does that seem helpful to you, or would you suggest a different structure? WhatamIdoing (talk) 18:23, 12 May 2025 (UTC)

I've left a message at User talk:2603:8000:101:A433:204E:F1D1:E319:AA92#May 2025. I hope that the IP editor will join us in this discussion. If they don't, then we can go to Wikipedia:Administrators' noticeboard/Edit warring to request a WP:BLOCK. I hope that it won't come to that. WhatamIdoing (talk) 18:21, 12 May 2025 (UTC)

Hamilton Medical sent one of its chief engineers to learn about this patented technology to meet the inventor, Fleur Tehrani, soon after her US patent 4,986,268 covering the technology in 1991 was published. Despite that, Hamilton Medical started to market the product in 1997 without any respect for the patentee's rights. The patentee had to take legal action against Hamilton Medical. In 2004, after Hamilton Medical had fought the inventor in the courts for several years, they decided to get a license on the patent. Based on that agreement, Hamilton Medical could only market the ASV mode in the US under the patent and its licensing terms. Therefore, ASV is a patented technology that has been marketed in the US under a patent licensing agreement with the inventor. All this information is publicly available and has been known for many years. Hamilton Medical is now trying to discredit the inventor by using the same material that it used without any success in federal courts for many years and to "retry" the case that it lost many years ago, on Wikipedia. The present description of ASV that has been attacked by several people in the past few days without any proper documentation and against credible information and evidence, does not give undue weight to anyone. It simply provides well-documented facts. Wikipedia should not support those who want to falsify facts. Fleur Tehrani (talk) 19:12, 12 May 2025 (UTC)

Welcome to Wikipedia, @Fleur Tehrani. Are you Dr. Tehrani? I'm asking because we have rules against impersonating other people by using their name as your username. WhatamIdoing (talk) 21:45, 12 May 2025 (UTC)

Yes, I am. Please read my reply above. Those who have been trying to change the description of ASV on Wikipedia in the past few days are falsifying the facts. Hamilton Medical fought me over ASV in the federal courts for several years. They were found guilty of willful infringement of my patent on a motion for summary judgment in the federal court in 2001. The federal circuit demanded a jury trial on the matter. The court never gave a final verdict in favor of Hamilton Medical. Afterwards, Hamilton Medical filed numerous motions at the federal court against me and lost all those motions. Then, Hamilton Medical decided to get a license on my patent. They signed that agreement in 2004 which would allow them to sell ASV in the US only under my patent (US4,986,268) and its licensing terms. ASV is a patented technology and has been marketed in the US by Hamilton Medical under license of US patent 4,986,268. The last 3 references that are used in the ASV description provide more details on this matter. Please stop this kind of vandalism. They are trying to use Wikipedia to spread false information after many years. 2603:8000:101:A433:E913:9D03:8C6B:59D0 (talk) 02:11, 13 May 2025 (UTC)

It looks like you ended up logged out again.

I guess what I'm wondering is: Why should anybody's patents (or business name) get mentioned in this article? We don't usually include that information, or if we do, it's only briefly (or for unapproved devices and drugs, about which business information is one of the few things that can be said with certainty).

Consider: Venturi mask: No patents mentioned. Smart insulin patch: No patents mentioned. Implantable cardioverter-defibrillator: No patents mentioned. Revivent: No patents mentioned. Digital pill: No patents mentioned. Cochlear implant: A patent mentioned in a single sentence (out of ~4,500 words).

Isn't there something more important to the world about ASV to be said here? Maybe something like having a shorter time to extubation[2] and it being just as good as Smart care/PS and PSV[3][4]? WhatamIdoing (talk) 03:36, 13 May 2025 (UTC)

It is actually important to mention if a technology is patented and I do not know why you question the importance of providing that information. The detailed information about ASV is found in the references that I have provided. The additional reason in this case is that some vandals are trying after twenty years to discredit me as the inventor of a lifesaving invention by spreading false information on Wikipedia. They lost their case in courts 20 years ago, and now they want to retry it on Wikipedia. In none of those cases that you have mentioned, the inventors had to deal with such people. Hamilton Medical had to sign a licensing agreement to sell ASV in the US under my patent and had to pay me thousands of dollars in royalty for each unit that they sold with ASV on it. Now they have come around again making all kinds of false claims against all evidence against me and you question why they shouldn't be allowed to vandalize Wikipedia? Wikipedia is not a platform for people to make false claims and should not allow that to happen. Please stop these vandals. They have no evidence against all the credible evidence. Fleur Tehrani (talk) 05:16, 13 May 2025 (UTC)

Who is the information important to?

If your doctor prescribes a drug to you, do you think it is more important to know what the benefits and side effects are, or do you need to know what the patent status is?

If you have a loved one in the hospital, and they need dialysis, is your first question about whether that's the right choice, or is your first question about whether any part of the machine is still under patent protection?

(I assume your invention is still under patent protection.) WhatamIdoing (talk) 16:00, 13 May 2025 (UTC)

There is ample evidence, the answer to point 2 above provides a summary of the litigation processes and their outcome. All public information. No discredit, no disrespect, just the facts. Here two references in support:

https://caselaw.findlaw.com/court/us-federal-circuit/1158485.html

https://www.11southsquare.com/notable-cases/tehrani-hamilton-ors-2021-ewhc-3457-ipec/ Josef X Brunner (talk) 15:51, 13 May 2025 (UTC)

Are you Joseph Brunner, the same engineer sent by Hamilton Medical to see me in California in 1991 who tried to take credit for my invention later? What you and Hamilton Medical did is a part of history now, well documented and known by many. If a technology is patented, it is important information for the public to know. What you are referring to as "ample evidence" is a ruling by the Federal circuit demanding a jury trial on the case that was decided based on summary judgment by the federal court. That was not a reversal of the federal court's ruling. They demanded a jury trial. After that, Hamilton Medical filed numerous motions in the federal court and lost all of them for more than one year. Hamilton Medical wanted to license the patent and have sold ASV under license of my patent and paid me royalties on each unit with ASV. Are you now trying to mislead the public by this kind of nonsense and claim that Hamilton Medical that begged at the end to license my patent, did so because it had won in the court? The legal documents on this case are ample, clear, and indisputable. You are creating vandalism against credible evidence on a public platform. Fleur Tehrani (talk) 16:41, 13 May 2025 (UTC)