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Online ISSN 1827-1596
Emilie BIALAIS 1, 2, Xavier WITTEBOLE 1, Laurence VIGNAUX 3, Jean ROESELER 1, Marc WYSOCKI 5, Johannes MEYER 4, Gregory REYCHLER 2, Dominik NOVOTNI 4, Thierry SOTTIAUX 1, 6, Pierre F. LATERRE 1, Philippe HANTSON 1
1 Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; 2 Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, Oto-Rhino-Laryngologie et Dermatologie, Université Catholique de Louvain, Brussels, Belgium; 3 Department of Cardiopulmonary Physiotherapy, Hôpital de la Tour, Meyrin, Switzerland; 4 Research and Development Department, Hamilton Medical AG, Bonaduz, Switzerland; 5 Research Center, Sainte-Justine Hospital, Montreal, Canada; 6 Intensive Care Unit, Clinique Notre-Dame de Grâce, Gosselies, Belgium
BACKGROUND: Closed-loop modes automatically adjust ventilation settings, delivering individualized ventilation over short periods of time. The objective of this randomized controlled trial was to compare safety, efficacy and workload for the health care team between IntelliVent®-ASV and conventional modes over a 48-hour period.
METHODS: ICU patients admitted with an expected duration of mechanical ventilation of more than 48 hours were randomized to IntelliVent®-ASV or conventional ventilation modes. All ventilation parameters were recorded breath-by-breath. The number of manual adjustments assesses workload for the healthcare team. Safety and efficacy were assessed by calculating the time spent within previously defined ranges of non-optimal and optimal ventilation, respectively.
RESULTS: Eighty patients were analyzed. The median values of ventilation parameters over 48 hours were similar in both groups except for PEEP (7 cmH2O versus 6 cmH2O with IntelliVent®-ASV and conventional ventilation, respectively, P=0.028) and PETCO2 (36±7 mmHg with IntelliVent®-ASV versus 40±8 mmHg with conventional ventilation, P=0.041). Safety was similar between IntelliVent®-ASV and conventional ventilation for all parameters except for PMAX, which was more often non-optimal with IntelliVent®-ASV (P=0.001). Efficacy was comparable between the 2 ventilation strategies, except for SpO2 and VT, which were more often optimal with IntelliVent®-ASV (P=0.005, P=0.016, respectively). IntelliVent®-ASV required less manual adjustments than conventional ventilation (P<0.001) for a higher total number of adjustments (P<0.001). The coefficient of variation over 48 hours was larger with IntelliVent®-ASV in regard of maximum pressure, inspiratory pressure (PINSP), and PEEP as compared to conventional ventilation.
CONCLUSIONS: IntelliVent®-ASV required less manual intervention and delivered more variable PEEP and PINSP, while delivering ventilation safe and effective ventilation in terms of VT, RR, SpO2 and PETCO2.