A feedback controller for the maintenance of FRC during tidal liquid ventilation: theory, implementation, and testing.

The necessity of controlling functional residual capacity (FRC) during tidal liquid ventilation has been recognized since the first description of this respiratory support technique by Kylstra et al in 1962. We developed a microcomputer feedback system that adjusts the inspired tidal volume (VT,I) of a liquid ventilator based on the end-expiratory quasi-static alveolar pressure (PA,EE), in order to maintain a stable FRC. The system consists of three subunits: (1) a tracheal pressure catheter to estimate breath by breath FRC changes, derived from PA,EE changes, and (2) a roller pump interfaced with (3) a personal computer in which a closed-loop control is implemented. The regulator sets the actual PA,EE against the corresponding desired value. Any discrepancy is offset by changes in VT,I and the required change in pump velocity is communicated to the roller pump. The size of any change in pump velocity is determined to both the observed and target or desired PA,EE (i.e., the error) and the (calibration) pressure-volume curve. To evaluate the efficacy of the controller, a set of laboratory bench tests were conducted under steady state and transient conditions. Closed-loop control was effective in keeping FRC and PA,EE near the desired level, with an acceptable oscillatory behaviour. The feedback controller successfully compensated for transient disturbances of PFC liquid balance. The steady state stability was confirmed during a five hour period of liquid ventilation in five preterm lambs.